Mood Swings

The gesture is so unexpected, coming from someone clearly suffering as much as Leah is. Lying in her makeshift bed as she has been for two days, a look of pain etched on her face, silently spelling out the words that she refuses to say. Instead, all she does is smile and tell us that everything is alright. 

"It's just a little painful when I move," Leah tells us, except that she can't move at all. The tell-tale sign of one leg appearing shorter than the other leads us to the quick conclusion that she probably has a broken hip - fractured NOF - or neck of femur. I remember wondering in the very early days of my career what a "nekkafeema" was, only summoning up the courage to ask after I could no longer hide my embarrassment at not understanding yet another medical term. 

Leah's son, a tall, sickly looking man of fifty, appears almost as old as his mother and at first I mistook him for her husband. He tells us that she had fallen almost a week ago. Since then, the pain has gradually increased, her mobility slowly becoming more and more limited until eventually she could move no more. 

"It's taken us days to convince her that she needs help!" Leah's son explains. "Every time I've picked up the phone to call you, she screams at me that she'll die if she goes to hospital." 

The smile on Leah's face cracks a little, like an ice-cube in a glass of water, still present but a little changed, and the polished facade she has paraded for her family and initially for us no longer holds strong. "It does hurt, but not too bad. Are you sure I need to go to hospital?" I explain that there may be, in fact probably is, a fracture, but the only way to tell for sure is to have an X-ray done. The old, well-worn joke that I left my X-ray glasses in the other ambulance rejuvenates her smile a little. 

We're lucky. Leah is lying on a strong sheet that we can use to manoeuvre her. She has cushions for support all around and we use all of these to help move her as gently as possible onto the trolley bed. The first couple of attempts catch her off guard, despite my warning that she would feel a little pain when we helped her across. It makes her grab hold of the bed railing and prevents us from carrying her from her bed to ours. On the third attempt, I make her promise that she keeps her hands still and if necessary grabs hold of my arms. That way, at least we'll still be able to keep moving in the right direction. It's a successful move. We're grateful for the lift that means we only have to transfer her once, rather than into a chair and only then on to the bed. Fewer moves means less pain. 

At the hospital, Leah withdraws a little, showing the apprehension that her son had warned us about. "Are you leaving me here now?" 

"As soon as we make sure that you're as comfortable as possible on a hospital bed, then yes. It's the hospital's turn to take care of you." She doesn't seem too keen on the idea, but resigns herself to it nonetheless.

"I have to tell you something," she says once she's calmly lying on the hospital bed. She motions me to stand a little closer, as if she has some state secret to sell. Suddenly, Leah grabs my face and gives me a kiss on the cheek, loud enough for what seemed like the entire department to hear. My crewmate laughs hysterically, sensing and seeing my embarrassment as my face glows a warm shade of red. 

As the first call of the morning, I feel that that one moment sets me up for the day and set off out of the emergency department with a smile firmly planted on my face. 

On our second call, a man dies in front of us with his family all around, and there's nothing we can do. 

Birthdays

Five o'clock in the morning and for the first time all night, we finally arrive back on station. Within seconds, before the engine has had the chance to cool, or the water in the kettle given the chance to boil, the phone rings again, sending us out on our next call. It had been one of those shifts. Job to job, patient to patient, hospital to hospital. With barely the chance for a bite to eat, we had inhaled cups of coffee throughout the night to keep our energies, as well as our hopes, alive and kicking.

Five minutes later we arrive at the address, still with no real details of what awaited us on the second floor of the dilapidated building. The only information we knew was that an elderly lady had pressed an emergency button and there had been no contact with her since then. The three of us grabbed the four bags of equipment and a carry chair between us and started the march up the stairs. Any hopes of there being a lift in the building were dashed the second we pulled up outside and saw its age. 

A tired, but determined voice answered our first knock. "I'm almost there, just give me a minute!" We waited, each silently praying for the clock to tick a little faster, for the end of the shift to arrive, for the calls to end so we could go home. As we did so, a shuffling sound from indoors became louder, like a dog scratching on a door trying to get out. Eventually we heard a key turn and the door opened just enough for us to peer in. 

"You'll have to push the door to get in, I've got no more energy left." Gently we did as were asked, guessing that she was leaning against the door, when after a moment we were able to squeeze in through the gap that had opened. The smile that greeted us was like that of a child seeing its very first snow. Pure delight shone from Eva's face, as if she had stored up ninety years of smiles for just this one freeze-frame. 

"I'm fine, really I am. I just need help to get up off the floor. I've been here for a little while, thought I could manage to get up on my own. Looks like I was wrong." 

"How long have you been there?" 

"Since nine o'clock last night." All three of us do the mental maths. Eight hours on the floor. Eight hours trying to solve the problem by herself that we would now solve in thirty seconds. We checked Eva for any injuries and found that, other than a small graze on her elbow, she seemed to escape unscathed. "I need two things from you please," she asked, almost pleaded. "First, I need you to make sure I'm steady enough to get to and from the bathroom. Eight hours stuck leaves a lady just a little in need of refreshment." 

She smiled her child-like smile again. 

"Second, and more importantly, I'd like five more minutes of your time. Just to have a look at something for me." Presumably a medical issue had been bothering her and now that she had readily available access, she would use the opportunity. 

"We're not going anywhere. Get yourself settled and I'll make you a drink first whilst you do." Once Eva was up on her feet, it took only seconds before she regained her balance, walking around the flat in a manner almost as spritely as a  teenager rather than a nonagenarian. 

"Just a few minutes. I promise. No more." 

When Eva returned, she asked us to follow her into the lounge, where we were greeted to a picture gallery of immense proportions. Every wall was covered, every bookcase had pictures on the shelves, every picture frame hid several pictures within it. Hundreds upon hundreds of pictures, each with smiling faces that crossed ages, generations, and eras.  

"These are my children. And my grandchildren. And my great grandchildren. I should have lost count by now, but I know. I know all their names, I know all their birthdays. Sometimes I might need a small reminder, just that the date is coming up, not that it's their birthday." She stopped just long enough to look once all the way around the room. "It's a birthday today, too, so I'm glad I'm up in time to go and celebrate." 

"Whose birthday? Which generation?" 

"Mine," she said with a wicked grin. "And," as she pulled out a hidden envelope with an old photograph of a young couple at their wedding, "my husband's too." 

I'd had a quick look around when I looked for the kitchen to make her a drink. There was no-one else there. Just Eva and now an ambulance crew. Definitely no husband. 

"Where is he? Your husband?" 

"He's in a home, just a few minutes walk, not far away. When his mind started to wander, his body sometimes followed and he would end up lost, so about five years ago we decided it would be safer to have him move into a home. I see him every day except Tuesdays. That's when I meet with friends for a coffee. Every other day, I always leave the house at six in the morning to get to the home in time to make his coffee and have breakfast with him." 

All three of us looked at our watches. Almost six o'clock. 

"I'm presuming you don't want to go to hospital and get yourself checked after your eventful night on the floor?" 

"Don't be ridiculous. Spend my birthday, my Izzy's birthday in hospital? No way. The only place I'm going is to visit him. And if you people are as kind as you look, you'll help me get down these stairs." 

"We'll carry you down if you like!" 

"Most definitely not. I've still got legs that work, haven't I?" None of us dared argue.

With one of us either side, we slowly walked Eva down the flights of stairs to the entrance of the building. She refused any further offers of help, from us accompanying her on foot, to the offer of a lift in the ambulance. 

"It's only five minutes away, I'll get there the same way I do every day." 

"Happy birthday," the three of us called after her as she started to walk away. 

She stopped, turned around and smiled that smile once more. "Thank you for making it so." 

Storyteller

Elaine stood over my shoulder, watching my every move. She'd been there from the second I knelt down beside her husband Carl. She watched every chest compression, heard every rib as it cracked loudly beneath my hands. And as she watched and listened, she told Carl's life story. 

"He lost his leg last year. Diabetes, you know. Awful disease. But he didn't really look after himself. It was probably his own fault in the end." 

She watched as two more crews entered and made a little room for them and their equipment. Then, as we worked in streamlined silence, she continued her story. 

"We're a rare couple we are. Carl from Jamaica and me, a working-class white girl from the East End. When we got married, back in the sixties, my parents swore to write me out of their lives. They never visited, we never visited them, and eventually we didn't even speak. There was no such thing as racism back then. It was just black and white. And no mixing."

She watched as someone stuck a needle in his arm and started to give him fluids and drugs. 

"When the grand-kids came along, suddenly they wanted to visit. But only if Carl wasn't home. So I told them they could choose. They either accepted our family as it was, or they couldn't be a part of it. It was the toughest decision of my life." 

She watched as a tube went down Carl's throat, allowing us to help him breathe a little more. 

"Our friends stopped being our friends. Blacks and whites each going their own separate ways, all of them turning outwards, away from us, instead of rallying around us and learning from each other. We were left with no family, no friends. It was just us. Carl and me and the kids." 

She watched as the first of the shocks jolted Carl's lifeless body off the floor, the unnatural jerk phasing her just a little, throwing her narrative into a brief silence.

"Is he going to be OK?" 

"We're doing everything we can for him, but at the moment the signs aren't good." 

"He's a fighter you know. He'd have to be, putting up with what we have. We've had to fight for everything. Over the last few years, though, we've finally been winning that fight. Mixed couples are all normal now, aren't they?" 

She watched another shock violently wrack his body and begged him to keep fighting.

"I love seeing them. Walking through the park, doing the shopping, wherever. And those beautiful children. Remind me of my own kids when they were little. Not that my kids aren't beautiful any more!" 

She watched as half an hour later, we stopped. Carl lay where he fell and Elaine knelt next to his head, her story told, muttering in silent prayer.

"Maybe," Elaine said after watching us clear up, "I'll write our story one day. Be good to have it written down once I've gone too, then someone else can tell our story." 

Missing

We spread out and search a room each. The police broke the door down, leaving the splintered remains of the frame lying all over the carpet, like a giant wooden pile of pick-up-sticks. Greg's worried neighbour had called the police having not seen him all day and seeing that his morning newspaper was still sticking half way out of the letter box. 

"He often goes out for the day, but he's never this late back and never leaves before reading the paper first." He stands behind us as we step into the house, brave and afraid in equal measure. "I just hope he's alright." 

Each door is opened slowly as the fear of what may be found behind it gnaws away at the back of all our minds. The kitchen and main dining room are empty, as are the other two downstairs rooms. One of them looks as if it had been locked in a time-warp for fifty years, with piles of newspapers tidily stored all around the room. 

Some houses give more of an eerie feeling than others and this is one of them. Only half the lights seem to be working, the doors creak and floorboards whine as the small army of police, ambulance staff and worried neighbours walks around fearing the worst, but hoping for the best. The search continues upstairs and follows a similar pattern. A gentle opening of the doors, initial relief at finding nothing and then a move to the next room. A more thorough search of each room, behind beds, in hidden corners, in the toilets and bathrooms reveals nothing. Greg isn't at home. 

Initial relief is soon followed by concern. The police start to take a more detailed report from Greg's neighbours, knocking on a few doors up and down the street to see if anyone could remember the last time they'd seen him, the latest time being the previous afternoon. The lady next door tells us that she's known Greg for over twenty years. 

"He has family, but they all live somewhere in the north of England. Come down for Christmas and his birthdays, but that's about it. He's fiercely independent and very stubborn. Never asks for help or anything. Loves his days out, goes everywhere by bus." 

We ask our control to contact the local hospitals, wondering if Greg had been taken ill in the middle of the night or whilst out and about on one of his gallivants. As they contacted each hospital they called us back to let us know the answer. No hospital within a ten-mile radius was looking after Greg and concern for his welfare was building. The police had called his relatives just to make sure that he hadn't headed north without telling anyone, but he hadn't contacted them either. 

As we were about to leave, a white van pulls into the road, the two men on board had come to fix Greg's front door and make sure the house was safe and secure. "We'd have been here sooner," said the driver as he stepped out of the cab, "but we got stuck behind a crash. Some old bloke knocked over about a mile down the road. They've only just let us through!" 

The coincidence isn't lost on anyone and worried looks cross a number of faces. Yet again, one of the officers gets on the radio and tries to find out the name of the victim of the crash. We all hear the reply. 

"No details yet. He didn't have any ID on him." 

We have no choice other than to leave the scene and leave the police and neighbours to deal with the missing Greg. As we drive up the steep hill towards the main road, we're given another call. A child somewhere is having an asthma attack. It puts an end to our mystery call. We turn left at the top just in time to see an older man walking in the opposite direction. Shopping bags in each hand, he strolls without a care in the world. On a whim, I wind down the window and shout. 

"GREG?" 

Nero's Virus

Clouds are building, the forecast downpour seems just minutes away. Set against the dark background is an unassuming row of terraced housing, the exact same kind that's seen in every part of town. One house, however, stands out from the rest. The brickwork is painted a glorious yellow, the window frames green, the colours complementing each other and brightening up a boring row of houses. The front door, its paintwork matching the windows, is opened by a character just as colourful.

"Oh good, you're here!" Burgundy trousers, black shirt and multicoloured waistcoat with matching bow-tie on a man who can only be described as a pantomime giant. "She's just upstairs. Think she's got that horrible winter bug. What do they call it? Nero's Virus? Not that I know what a Roman emperor's got to do with viruses."

"That'll be norovirus."

"I prefer my version. Got more class to it."

"To be honest, I do too. I think we'll use that from now on."

As is always the case when patients are sick, she's in the bedroom on the top floor of the townhouse, two flights of stairs up. Vera is John's total opposite. Dressed in dark pyjamas and wrapped in a plain dressing gown, her dress sense and tiny body are completely out of character with her house and incongruous with her theatrical husband.

"It's been three days now," John tells us. "She can't keep anything down. It just comes out almost instantly, one way or the other. Even water."

"I'm sorry we had to call you gentlemen." Vera talks in between attempts to empty any remaining contents of her stomach. "We just didn't know what else to do. We've tried all the over-the-counter stuff. Nothing works. Every time I try to stand up, I feel like I'm going to keel over."

We check her vital signs and find that her blood pressure is low, which explains why she feels faint whenever she stands up.

"Lets get some fluids into you before we move, then we'll get you on a chair and up to the hospital."

"Do I really need to go?"

"I think it's probably for the best. You can't keep going with the blood pressure of a five-year-old."

She sighs. "I've never had to go to hospital in my life. And when you're as old as I am, that's a long time!"

"Well, if that's the case, it's about time you saw what all the fuss is about. I'm sure they'll look after you."

"Alright then. Do what you need to do."

We give Vera some medication to help stop the nausea and she gets some fluids too, enough to make sure her blood pressure is a little more settled before we start moving her down two flights of stairs. Once we're ready, she takes a seat on the folding chair, we wrap her in a blanket and secure her with the bright yellow strap. Half way down the first flight of stairs, the lights go out, and the house is left in complete darkness. I manage to fish the pen-torch out of my top pocket whilst balancing the chair with one hand and with the aid of my belt, bite the torch between my teeth, and we manage to get down the last few stairs. There was another flight to go and dim light wasn't quite enough, so we stopped on the landing. 

"Hang on a minute," says John, "I think I remember seeing a candle in the draw upstairs. Lend me that torch and I'll go find it." A minute of darkness later, he comes back with the candle. "Only one problem," he says. "The matches are downstairs in the kitchen." 

"Don't worry," laughs my crew mate, "I've got a lighter." 

"Well, how about that then! Haven't had a powercut in these parts for years! It's a miracle I still had that one candle. Left over from her birthday cake, the one the kids brought over last month." 

A combination of candlelight and torchlight saw us the rest of the way, until we reached the street that was lit up by the flashing blue lights. As we were about to step out of the house, Vera remembered the one thing she wanted. 

"Will you bring my walking stick with you? I can't go anywhere without it."

"Are you sure you want it? We've strapped you in to the chair, it's on wheels, and you're going on a trolley bed. You're not exactly walking anywhere."

"Still, I'd really rather have it." 

"OK, where is it?" 

She hesitates, almost scared to answer the question. "It's in the bedroom." 

Vera smiles as I tut theatrically and roll my eyes. "Let's get you comfortable in the ambulance, then I'll go and get it. But you're sure you want it? Walking sticks have a habit of going for walks without their owners in hospitals." 

"And the way I feel, it could probably walk a darn sight quicker!" As we helped her across to the bed, she vomited once more, and we got a bowl to her just in time. 

"Wouldn't want to get your pyjamas in a mess, would we?" We covered Vera in the blanket that had kept her safe as we carried her downstairs and tightened the strap around her legs, telling her it was just to make sure she didn't run off. "By the way, you don't own a fiddle by any chance, do you?" 

"A fiddle? Why do I need a fiddle?" 

"Oh, you know, it'll give Nero and his virus something to do..." 

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." 

Windows

Tiny drops trickle down, zigzagging along

the inside of the steamy window, 

leaving streaks,

like tears, 

on a pockmarked face. 

Inside, they lie, 

side by side. 

He watches her, holds her, 

caresses her lifeless, cooling hand,

begs her to stay, despite knowing,

knowing she's gone. 

We step inside and take one look. 

Inside, the image in the window is mirrored, 

as tears stream down his gentle, pockmarked face. 

Cycles

A children's channel shows quietly in the background. A young boy sits in a corner of the entrance hall trying his hardest to keep his eye on the television, as all around him chaos reigns. Dozens of people are in the house, men in one room, women in another. Children wonder between the two, the younger ones chasing each other, playing happily, their childhood seemingly unaffected by the grown-up reality all around them. 

A middle-aged, grey-haired man meets me at the door and guides me towards a side room. The house suddenly becomes silent as they see, hear and sense the intrusion of an unknown guest. Dozens of eyes follow me through the narrow corridor. Another man, of similar age and strikingly similar features to my guide joins us. He puts his hand on the handle, and just before we enter, he stops to explain.

"My name is Deepesh, and this", he says, pointing to the other man, "is my brother. I'm sorry you were called. There is nothing for you to do, but they said this was the only way." 

Deepesh opens the door, and motions me in. Two women are sitting at the other end of the room, their chairs angled gently towards each other. One wipes tears away as the other sits reading prayers from a book. Between them, lying on the floor and covered up to his face in a white sheet, is an elderly man. 

"He died a few hours ago," said Deepesh. "We called the family just before, when we knew he was in his last moments. Many of them have been here since then, many have joined us in the meantime. It is how we help his soul on its way. My sister and aunt, his sister, are the ladies in the room." 

It was the aunt who was crying. 

"We called the doctor to tell him that my father had died, but it was after hours, so they said we had to call for you. All we need is the certificate so we can prepare the funeral."

The call had been dispatched as a cardiac arrest. That would mean at least another three pairs of hands were on the way, possibly even four. I'd left the car and headed for the house with several bags full of kit and ready for a resuscitation. As soon as I had reached the front door, I knew that the equipment was surplus, and that any efforts would be futile. The calm, sad acceptance written on Deepesh's face told me all that I needed to know. As soon as I had seen his father, I called off the reinforcements. Distant sirens fell silent moments later. 

"We knew he was dying. A year ago, he was given three months, but he fought on. He wanted to see his first great grandchild. She was born last week, and he held her yesterday for the first and last time." 

Deepesh called to one of the children, and following an apology to me, asked them something in a language I don't understand. The child, a young girl of six or seven, her long dark hair tied in a plait, looked at him as if he was crazy. He, in turn just confirmed his request with a gentle nod of the head. A minute later she returned holding a digital camera, and handed it to him. He pressed a couple of buttons, and showed me the screen. Sitting there, a broad smile across his face and cuddling a tiny baby, was the same man who lay lifeless on the floor only one day later. 

"He knew it was his time." Deepesh wiped away the hint of a tear and stopped for a few seconds. "Only yesterday he sat holding the baby, and all he kept talking about was the cycle of life." 

Grown up children

It's always good to have helpful family on scene, 

particularly children assisting their parents. 

Sometimes, however, I forget,

that if my patient is 90-something years old, 

the "son on scene", 

or "daughter on scene"

are not going to be kids,

but very likely to be in their seventies... 

Bystander

I decided to try something different, and write this post from the point of view of the bystander. Sometimes it's easy to forget that they might be more affected than the patients...

__________________________________________________

They came thundering in like a stampede across the savanna, bags on their shoulders and equipment in their hands. I directed them upstairs, and told them the same thing I'd explained to the gentleman on the other end of the phone. I think it's too late.

It was the first time I'd ever had to call for an ambulance, and I only called because I didn't know what else to do. Lily and Ted had been my neighbours for as long as I could remember. I never really left home, visiting regularly throughout my university years and even the first few years of my marriage. They adopted me as their own, and my children were the grandchildren they never had. When my parents died within weeks of each other, we renovated the house, and instead of selling my childhood home, we sold our house and moved back in.

"Uncle" Ted and "Aunty" Lily were family, whether they were related to us by blood or not. My kids adored them as much as I did. We ate together, spent days at the beach together, celebrated birthdays and anniversaries together. So when Lily knocked on my door early that morning with tears in her eyes, I knew.

They came rushing in, four of them, their green uniforms and tired eyes showing signs of another night shift nearing its end. And yet, the speed and energy with which they came bundling through the door, well, it was as if they had only just started. All the while, I knew deep down that it was too late, but just for a minute, watching the paramedics running up the stairs, I dared to hope that maybe they knew something I didn't.

Moments later, the first of them came back downstairs, empty handed and sullen faced.

"I'm sorry," he said, genuine regret in his eyes, "there was nothing we could do. I'm afraid Ted's died."

He went on to explain that Ted had probably passed away during the night, and probably just drifted painlessly away in his sleep. I was glad to hear that. Small mercies are all we have to grab on to when there is nothing else left to do. Lily was sitting by the table in the kitchen. She knew too, but somebody had to tell her. I didn't have the strength to do it, so I asked him if he would. He put a comforting hand on my shoulder, nodded gently, and walked towards the kitchen.

"He's died, hasn't he?" asked Lily, her voice as broken as her heart.

"I'm afraid he has. It's probably been some time, and it looks as if he just fell asleep."

He was so kind, that paramedic, I wish I'd asked his name. In fact, they were all so kind, but I could hardly remember any of their faces, so I'd probably have forgotten their names too. Once they'd cleared up, they each came in to make sure Lily and I were OK. One of them made us tea, the sweet, warm liquid slowly thawing our numbed minds. It's the drink that cures all ills, at least temporarily. For Lily, and thinking back to my own parents, I feared that this might be the beginning of the end. She promised to stay strong - she meant it, too - and I promised that I would always be there for her. From the day Ted died, six weeks ago today, I checked in on her at least once a day, even though I knew that she had carers twice daily, morning and evening. 

Then, tonight, the carer knocked on my door. She couldn't get in to the house. Lily wasn't answering the door, and the key was still in the lock. As soon as I walked up to the house, I knew. The police broke the door down, and once again the green uniforms went rushing in. Once again I hoped I was wrong. Once again, as the first paramedic came back downstairs, I knew that I wasn't. He put an arm on my shoulder, told me what I already knew, and that he thought that Lily had obviously decided that she couldn't live without Ted, and had chosen instead to join him. 

As I looked at him properly for the first time, I was surprised, but relieved. This was the same paramedic who'd been here when Ted died. At least he understood. At least he knew. He knew that I was not just a nosey neighbour, that I was more than a simple bystander watching it all from the sidelines. It wouldn't make a real difference in the long run, but at that moment, as I stood there engulfed in sadness, it just felt right.

Two Feet

The rain is pouring down and I can't help but step across some muddy grass to get to the front door. I ring the doorbell and am thankful when it only takes a few seconds for Wendy to open the door - a torrential downpour is not my favourite choice of climate. As she pushes the door outwards, she looks back into the house and shouts. 

"They're here!" 

I wipe my feet and as I walk in I accidentally catch the strap of the bag on the door handle. 

"Can't your mate help you carry any of that?" 

"It's just me for now. There'll be another ambulance along soon enough." 

"Well, I don't know how you're going to get him off the floor on your own! I mean, he's been there for hours, and I've tried all I can do. He just keeps shouting at me that it hurts!" 

"Let's have a look and see. If I can help him on my own, then we'll do that. If not, I'll make sure he's comfortable, and we'll wait for a couple more pairs of hands." 

Clive's lying flat on his back, his legs in the kitchen, whilst his head and torso are out in the narrow corridor. It's rarely that these falls occur somewhere simple, and I have no choice but to step over him repeatedly, assessing for injuries and vital signs. 

"As long as I lie still," Clive's voice has a sing-song quality to it, "I really don't feel that ill. But if I try to get up or move, well, that's a different kettle of fish altogether." 

"Where's the pain?"

"In my left hip. I've already had the right one replaced, and I expect I've got the same treatment coming up now on the other side." There's no way I can move him on my own, and I've just been helpfully advised that the nearest crew may as well be in France. 

"The boss tells me you've been down here for hours. What time did you fall?"

"Oh, no. I only fell about ten minutes before she called you. She gets a little confused at times." He whispers the last bit, hoping not to upset his wife of more than fifty years. 

"I heard that!" She yells, out of sight, but clearly not out of earshot. "I don't get confused, thank you. Just forgetful!" 

Clive beckons me nearer. "Forgetful then, but selectively good hearing too."

"OY!"

"Told you!"

The crew arrive over half an hour later. In the meantime Clive's had all the pain relief I can safely give him, any minor wounds have been bandaged and I've strapped his legs together to try to take some of the strain off his hips. It takes about the same time again to manoeuvre a scoop stretcher into place to try to get him out the house. 

We split the scoop in two, separating the hinges at each end and gently move each side underneath him. We need to keep him as straight as possible to avoid moving his hip, but there's no way the now rigid stretcher will make the turn around the tight corner and into the narrow corridor. We try moving further into the kitchen to get a different angle, then try again to move in the opposite direction. The only success we have is in leaving dark footprints on the cream carpet. 

"I'm sorry, Clive, but there's nothing for it. We're going to have to stand you up. But don't worry, we'll keep you on this stretcher, strapped in, so you won't actually be standing at all. Is that all alright with you?" 

"No problem. Just do what you have to do." 

We add some extra straps for support, forming a "figure-8" around his feet and the bottom of the scoop, ensuring that when we stand him up, he won't move anywhere. 

"You can close your eyes if you like, it's probably a bit of weird sensation rising like a zombie." 

"With all that stuff you've given me, I feel like a zombie anyway!"

"Ah. That'll be the morphine. Told you it was good stuff." 

"You weren't kidding!"

After more to-ing and fro-ing, furniture moving and a few more wet, muddy footprints on the carpet, we finally manage to get Clive out to the ambulance and make sure he's as comfortable as possible for the journey. His wife joins him, and just before I shut the doors, I apologise. 

"Sorry about the footprints. If there's a next time, which I hope there isn't, I'll come in barefoot. Failing that, you could try calling when it's sunny instead." 

"Don't worry about it," says Clive. "Hopefully the next set of mucky footprints on there will be when I'm back on my own two feet." 

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.

Milk Bottle

Two bottles of milk by the front door,

A neighbour sensed something was wrong.

"She has one bottle delivered each and every day!"

A light was on,

The television flickered through a sliver of open curtain,

But there was no answer to our calls.

A kick, another kick, and the door splintered open.

In the kitchen, by the table and an upturned chair,

She lay where she fell.

A bowl of dry cereal sat waiting,

For an unopened bottle of milk.

Being Human

We wheeled her husband to the ambulance, even though he wasn't all that ill, but he definitely needed to be in hospital. We made sure he had everything he needed, and even some things that he probably didn't, but would make him feel more at ease. A dressing gown, a pair of slippers, his favourite walking stick and his green-framed reading glasses.

"Can I get you all a drink?" asked his wife.

"No thanks. We'll get a coffee at the hospital."

"Are you sure? It's really no trouble. You've been so kind!"

"Sure. You don't need to trouble yourself."

She looked almost disappointed at our refusal, so we softened the blow by explaining that the quicker we get her husband up there, the more chance we had of beating the drunken rush of a Saturday night. At the age of eighty-several, they both looked after each other, rarely asking for help from anyone else. As we wheeled him into the ambulance, she wanted to check that he was comfortable.

"Can I just make sure that he's OK in there?"

"Of course you can."

The ambulance was about fifty metres away, and she gladly accepted a helping hand, holding my arm by the elbow to steady her gait. She looked in, checked on her husband, dismissed his assurances that everything was as it should be, and made sure to remind us to look after him. Still holding on to my arm, we walked back to the house, and made sure that she was safely behind the glass doors.

"Thank you. You've been most kind to us."

"A pleasure. We'll take good care of him, just make sure that you take good care of yourself."

"Don't worry about me. I'm fine."

I turned and headed back to the ambulance, and took a final look back to their front door. She was still standing there, keeping a close eye on proceedings. Just before I stepped out of sight, I waved.

She waved in return, made sure to lock her door, wiped a tear, and then blew us all a kiss.

Sometimes it's not about the latest kit, the newest ambulance or the fastest treatment.

Sometimes it's just about being a human being.

Overheard

"It's my ninety-ninth birthday today!" Said the gentleman at the polling booth this morning. He walked unaided, no stick, no frame, and looked the picture of good health. 

One of the officials in the hall showed her amazement. "You look incredible for seventy, leave alone ninety-nine!" 

"I don't take medicines, and I've never seen a doctor or been to hospital, either." 

"What, never?" 

"Well, except once. That was after I fell out the sky after being shot down over France during the war. Broke my leg then, but was back flying six weeks later." 

The four ladies monitoring the voting all stood up and applauded, and everyone else in the hall joined in. One of them, having put down her newspaper and pencil, asked him what his secret to a long life was. 

"Very simple!" He said. "Just make sure you wake up every single morning for a very long time!"

Apologies

This is an open letter to the driver of the car behind me earlier this morning: Stand by for a rant.

Dear Driver of the BMW X5 that was behind me in traffic,

I hope you read this - I gather I owe you an apology.

I'm sorry I stopped in front of you at an inconvenient moment.

I'm sorry I blocked your lane, (even though the other one was clear).

I'm sorry I stopped to help the elderly gent who fell right in front of us.

I'm sorry I took a few minutes to help him and make sure he was OK.

I'm sorry you may have been a little late to your coffee morning or other meaningless task.

But if I ever see you, your car, or the horn you beeped at me repeatedly,

You selfish, arrogant, ignorant, rude and insensitive person,

I may not be responsible for my actions.

Oh, and as for your apology, I shan't hold my breath.

Signs of Life

A thin sliver of sky turned from dark to dawn as a new day started to break over the horizon. Birds hidden in the leafy trees sang their chorus as two ambulances arrived simultaneously, shattering the peace. A police officer stood banging on the front window trying to raise the occupant's attention. As we joined him, a neighbour approached. 

"She hasn't moved from that chair for days. I reckon she's dead by now!"

"And what made you call us this morning, instead of days ago?" 

"Not sure. I was just about to go to work, I'm a tube driver, y'know, that's why I start early and thought that this is ridiculous. So anyway, I called the Old Bill. Why don't they just smash the door in?" Six sentences all at once left me wondering which to deal with first. 

"I think they need to make sure that that's absolutely necessary before they take drastic measures. Believe me, if they think that they need to, they will." 

I stood alongside the officer at the window, and could see now why they weren't breaking the door down. Despite the occupant being somewhat obscured by a television and some other household furniture, we could clearly see the rhythmic movements of someone breathing regularly. 

"She's deaf y'know!" We all turned to look at the neighbour. "Last fifteen years she can't hear a bloody thing if she ain't got 'er aids in! I think she leaves 'em out on purpose sometimes!"

"You didn't think to tell us that ten minutes ago when we started waking the neighbourhood?" 

"Errr... Sorry." 

"How old is she, anyway?"

"Dunno. 'Bout eigh'y, nine'y I guess." 

A police van turned up carrying the duty sergeant who was quickly brought up to date on the story so far. I shot him a mocking look, knowing that it's rare for stripes to come out when it's dark. 

"Slow night." He shrugged and smiled. "Fancied some action!" 

He suggested using the van's search light as a last attempt at waking the probably slumbering lady before having no option and breaking in through the front door. All we needed was a sign of coherent life, and we could leave her alone. 

The van was moved onto the vacant driveway. Apparently she "gave up driving when she gave up listening." 

"Well," said the sarge, "if this doesn't wake her up, we'll have to use a heavy boot. Just make sure that if she does wake up you turn the beam off straight away. Either that or she'll be blind as well as deaf!" 

The light was switched on, and the beam hit the target straight in the face. She stirred after a few seconds, and the searchlight was turned back off again, as ordered. As we all breathed a sigh of relief, she opened her eyes, picked up one of her hearing aids from the coffee table next to her and marched towards the window. She fumbled with a small key, unlocked the double glazed window, opened it only a few millimetres and turned her ear towards it. 

"Sorry to wake you ma'am," starts the sergeant, "we were worried something was wrong, and had to make sure you weren't injured or ill." 

"Thank you officer. As you can see, I'm fine. No need for anyone to worry." 

"We have the ambulance here too, if you'd like to let them in. They can just make sure." 

"I don't think that's necessary, thank you." 

"Are you sure?" 

"I'm sure. Don't worry... Actually," she said having paused for a few seconds, possibly debating the idea of a home-visit check-up, "there's just one thing you could do for me, if you don't mind?"

"Sure. What's that?" 

"Just F*** OFF AND LET ME SLEEP!"

She slammed the window shut, locked it, and made a point of showing us all that she was once again removing the hearing aid. As she sat back down in her armchair, she looked round the television that obscured our view, raised her arm, and as a final wave goodbye, stuck up her middle finger.

"That'll do!" I said. "I reckon that's enough signs of life for me!"

Monday Mornings

Monday morning. A curse for many, a blessing for some. The day breaks on the horizon as I head towards what will almost certainly be the last call of the weekend, with the car sounding almost as tired as I am. Thirty six hours over three night shifts, almost seventy activations, with over thirty patients attended. It's been a busy weekend. 

Henry, well into his eighties, is woken by a crushing pain in his chest and his jaw. 

"Call an ambulance, love. I think my heart's playing up again." He tries to stay calm, putting on a facade for Lena's benefit, but after more than fifty years together, she sees straight through it. Once she's called the ambulance, she wakes up her neighbours and asks them to come in. 

"Just to help me keep an eye on him. You don't mind, do you?" 

Their neighbours are young, and always willing to help. I meet them first as I pull up outside, barely five minutes after the call has started. 

"Thanks for coming so quick. I've hardly even put the phone down! Henry's upstairs." Lena's calm exterior  as she watches me climb the stairs does little to hide her anxiety, and as I step in to the room, I ask her to take a seat next to her husband so she can see and hear everything that's going on. 

Craig, the neighbour, gives me a quick rundown of Henry's history, a heart attack nearly twenty years ago leading to a series of another four over the years. 

"I think I'm running out of lives!" Henry says, only half joking. "I guess I'm lucky to get this far. I think it's Lena's fault that I'm still going. Who else is she going to nag to take out the rubbish?" 

She glares at him and tells him to keep quiet. 

Henry's pulse is irregular, a rate of anything from the low thirties up to nearly one hundred. The ECG shows that the heart's struggling, not getting enough oxygen to where it needs to be. Another heart attack seems just around the corner, and as the second ECG strip prints, I hear the crew arrive. 

"Bring a carry-chair up with you please!" I call down. One set of footsteps keeps heading up the stairs whilst the other heads back out to the truck to get the chair. 

"Meet Henry," I say to the attendant. "He's eighty-five years young, and has a habit of causing Lena stress by having had five heart attacks in the last few years, and his heart isn't particularly happy at the moment." I show the attendant the ECG strip, and he concurs. 

The pain had eased a little since I'd given Henry a lemon-flavoured aspirin and spray of GTN under his tongue. That should help open up the blood vessels that feed the heart, easing the problem at least temporarily, if not solving it altogether. The ECG remained unchanged after we had loaded Henry into the ambulance. His heart was sick, and so was he. Lena wasn't far behind, worrying about her husband. 

Once we had reassessed Henry, cannulated him, taken some of his blood, and given him some more medications, I stepped out of the back of the ambulance and headed back to my car, closely followed out of the treatment area of the ambulance by one of the crew. As she was about take her seat behind the wheel, Craig approached her. 

"Make sure you take good care of both of them, won't you?" 

Loading the luggage into the boot of my car, and with my back to them both, I couldn't believe as I overheard her answer. 

"I'll do what I can. But it's late, it's Monday morning, I've worked all weekend, I'm tired, and I just want to go home." She got in the cab, and within seconds was driving away. 

I left half my kit on the road, and went back to speak to Craig. I don't know why I felt the need to apologise for somebody else's behaviour, but I just felt it was inexcusable. 

"I'm sorry about that. I don't really know what to say!" 

"Don't worry about it. It's not you who needs to say anything. Anyway, thanks for your help. I hope Henry'll be OK." 

"They're taking him to the best hospital in the area for cardiac care, and I'm sure they'll do all they can for him.  If you wait an hour or so and then give them a call, the hospital might be able to give you some details on how he's doing." 

"Hope so. I suppose I'd better go get ready for work now. Back into the real world again after the weekend." 

"Ah. Yes. Forgot about that. It's Monday morning for you normal people." 

"Yup. For normal people and grumpy ambulance drivers." 

*****

We meet dozens of people every week, be they patients, relatives, friends, or neighbours. They all blur into one after a while. For us, these calls become routine, emotions become dull, and we feel disconnected. For us, it's a coping mechanism. There's no way we could feel what they all feel, and still be able to do our job.

The patients, however, their friends and family too, may only ever meet one ambulance crew. If the impression they're left with is one of "grumpy ambulance drivers", somewhere along the line, not only do they fail their patient, but we all do.

In amongst all the skills we use, and the knowledge we possess, showing that we care, even if sometimes we struggle to do so, may be the most important thing that we do.

Especially on Monday mornings.