Evidence

She's wearing a long black coat, fake fur around the collar, like she's wearing a fox for a necklace. And although the sun has already set, sunglasses rest on her head; gaudy, silvery arms that hold on to giant darkened lenses. One of the lenses is shattered but still intact, as though a spider had built its web all the way across. Her handbag, with its plaited rope handle still loosely around her arm, has spilled its contents across the pavement. Lipstick, coins, old receipts and chewing gum are sprawled across the ground much like their fallen owner. 

On the outskirts of the scene, it's like trying to empty flood-waters out of a sinking ship with a teaspoon. Two police officers fight back the threatening crowd, as a third attempts to tie the blue and white tape across the only access that doesn't involve climbing a fence. Each time he ties one end, someone tears down the other. It takes the threat of a taser before the massed mob take a hesitant step back and as they do, back-up arrives, giving the police more of a chance.

We're in the middle. Surrounded on all sides of the open ground by people who could be friends or foe of our patient. They could be idle bystanders too. Some may be able to tell a story, to give us some facts, some history. But none could tell the story as well as the obvious evidence on the ground.  

We walk up to her, through the mob, through the strategically placed line of officers, through the spilled contents of her bag, through the pools of blood and golden, gleaming bullet cases, through the torrent of screams and curses and cries for us to do something. 

As the mob takes a step closer and holds its collective breath, one look tells us that the evidence - the handbag, the glasses, the bullets and blood and broken skin - is overwhelming. Even the mob knows: there is nothing more to be done. 

Footprints

Bright red footprints, like they'd been painted in a playground, appeared on the steps that we were hurriedly climbing. Not every step, only some. Every second or third stair was marked by a print hastily left by whomever it was that had either caused this horror or, at the very least, discovered it. We would never know whose prints they were, but a clue had been left for the police to use in their hunt. Each mark, no more than half the sole of a shoe or a boot, was as red as the next, each as incriminating as the next, each as foreboding as the next. As we ascended three flights of stairs, the footprints descended at speed. 

The floor and the walls are awash with red; pools and clots and smears and streaks. And footprints. And in the middle of it all, she lies, barely breathing, barely conscious, barely alive. Two police officers search the house as we start to treat her. The scene is no better in the tiny bedroom or bathroom. She had tried to escape and was cornered, prevented from fleeing by the force of a knife, and by her lifeblood draining away. Eventually, she fell by the front door and there she lay, waiting, in a motionless race against time. 

It took time to get her out, as we stepped out of the sea of red, time she didn't have. We couldn't bandage each wound; they were too many, and the minutes too few. We could barely stem the bleeding, although, ominously, it seemed to be slowing of its own accord. Four pairs of hands carried her on the backboard down the stairs, following the footprints and leaving some more, but this time each step was marked. Prints of different sizes, different shapes, but each dipped in the same red paint. 

At the hospital, they're ready for her. Bags of fluids and blood hang at the ready the instant we set foot in the resuscitation room. Oxygen can already be heard hissing out of the tap. Nurses and doctors take over the treatment. Orders are barked, instructions carried out, messages relayed. She's still breathing, still conscious, still alive. 

Outside, as we start to clean up, the police are waiting for us. They want the prints from all our boots. One by one, each police officer who had entered the scene, each paramedic who took part in the call, steps somberly on and off shoe-shaped pieces of card. Each leaving a pair of gruesome footprints - the imprints that would rule them out of the investigation - but would leave a mark in their minds. 

Inside, in the meantime, as the footprints dry, she dies.  

Memories

Flashback. 

A totally unexpected flashback that instantaneously took me to the scene, one I hadn't visited for several years. 

The mind plays tricks on me, sending me back into the adrenaline rush that I remember as though it was yesterday instead of yesteryear, I feel my heart pound with the same sense of urgency and excitement, hear the sounds as though I'm still there and see the sights as though looking at freshly printed photographs.

As I sit propped up against the wall, the view around me clears, the sounds of the crickets chirping away float in on the breeze through the window, the dimmed city lights come into clearer focus, I remember instead of dream. 

Sonia stood by the side of the road in amongst the crowd but strangely apart from it. In that early, drizzly evening the bus stop was filled with people, some genuine passengers waiting for the bus to take them home, some undoubtedly who had stopped especially to witness the scene. A few stood with their phones in their hands, taking photographs or videos to be shared later with their friends or family or perhaps the world. Maybe if I checked YouTube later that day, I'd see freshly filmed footage of our work. 

It's all too common, the menace of the casual observer. It's tempting to shout, plead for the crowds to disperse and respect the patient's privacy as though it was their own mother or father, but even when I do, nothing seems to happen. More often than not, it's easier to leave them be and carry on with the work that needs to be done. The privacy we are sworn to protect is trampled on by anyone on the outside with a digital recording device of any sort, but we are powerless to stop it. 

Sonia was different, telling me her name as soon as I got there. She stayed perfectly calm amongst the baying crowd that was now being held at arm's length by the police cordon and an angry sergeant. Her hands stayed either in her pockets or on her hips as she just watched, making sure she was always as near as possible. It was unnerving at first. She was already there when I first arrived in the car, holding his hand as they waited. But as soon as I stepped in, she took her spot on the pavement and just watched. 

"Do you know him?" I called out to her. She shook her head as I attached an oxygen mask to his face. 

"Did you see what happened?" Same response, an almost detached but fascinated look in her eyes. 

As I started to check his blood pressure I notice that his breathing has become a little erratic, making me abandon the pumped-up cuff on his arm and move back to his head where I take over the breathing, the reservoir bag on the bag and mask filling with life-saving oxygen which I then pump into his lungs one gentle breath at a time. The ambulance crew arrive just as he starts to become difficult to manage, fighting the mask, fighting us, fighting an invisible terror. 

Sonia takes an audible gasp. Someone in the bus stop laughs and turns their camera towards her. I look up to see her mouth one word: Sorry. 

He's loaded into the ambulance, the backboard and straps hold him in place as the crew prepare to transport him. 

As I'm packing away the equipment and a white tent is set up over where the patient was found, I notice the police are talking to several of the witnesses, Sonia amongst them. I leave the bags by the car, knowing that for now the kit was protected by the invisible force-field afforded by the police tape, and step over to her. 

"Are you sure you didn't know him? You didn't see anything that happened?" 

"I'm sure. He was just lying there and it felt like the right thing to do, just to hold his hand." A tear streamed down one cheek.

"You seemed interested in what we were doing, more than most. Are you OK with everything? I know it wasn't too nice to watch what we were doing." 

"I'm fine. It was just something I had to see." 

"Why?" 

"Because I don't remember anything." 

"What do you mean you don't you remember?" 

"Last month, that man lying in the road was me. And I just don't remember." 

Jimmy

One two seven High Street, Suburbia.

I know that address. I know that it's not where we're actually needed. It's the centre where emergency calls made by mainly elderly patients hitting a panic button are received. The computer instantly recognises the address from the phone number and dispatches us anyway. Two miles down the road, the address updates and sends us three miles in the other direction.

The call is given as a possible collapse. Someone has pressed the panic button and then contact was lost. All attempts to reach the ninety-four year old, either through the emergency call box or by phone, failed. There was even a mobile phone number on the records, a rarity for someone of that age, but it appeared to be switched off.

With no other options, we were sent. The next of kin, a great niece who lived somewhere in the middle of nowhere, had been woken up and informed of the problem, but even at top speed couldn't get there in under two hours. The police, as is so often the case, had sunk under a tidal wave of their own calls and had no units to send. If there was any need to break in to the house, we'd have to do it ourselves.

As we pull up outside the house, the computer updates with the latest message - there's a key safe hidden behind a pot plant - so no need to break down any doors. As I punch in the four digit code and push open the lock, a bunch of four keys falls onto the floor. There's only one door and one lock, so the need for four keys is unknown, but on the third guess, the key moves the lock and allows us inside.

The house is in total darkness. There's no sound either. Initially I use a torch to find our way round, but feeling too much like a burglar, we opt to switch on the lights. We search the downstairs and find nothing, except for the reason for the other keys. Each door, one to the kitchen, one to the lounge and one into a dining room that looked as if it had been accidentally left behind in the 1800's, was locked. On closer examination of each room, we find them uninhabited.

There were three rooms upstairs too - a bathroom and two bedrooms. In the second bedroom, oblivious to the two strangers wandering around his house calling his name, was Jimmy.

A gentle, almost inaudible snore emanates from the sleeping man and his breathing is calm and restful. Strapped to his wrist, unmoved by the commotion, is his panic button and next to him on a small bedside table is a barrier between between Jimmy and the outside world.

A pair of hearing aids.

We creep back down the stairs, turn off all the lights, lock the door and replace the key in the safe box. As it clicks gently back into place, we both, almost subconsciously, mutter the same three words.

"Good night Jimmy."

Bad Weather

Heading through the terrible weather towards the scene at right angles to the accident, the level of carnage looks all the more brutal. We're the third ambulance to arrive, adding to the sea of flashing lights. Rain drops look like tiny blue specks of light, reflecting the LEDs from all the emergency vehicles. Police cordon off each end of the street as fire crews start to cut through the mangled remains of what used to be a private car. The two occupants of the first car have managed to escape their wrecked former mode of transport and walked away with nothing but scratched arms and, for the driver at least, a bruised ego.

The other driver wasn't so lucky. Trapped in his seat by the crumpled front of the car, his head pinned back by the first paramedic on scene, all Terry wanted to do was move. One quick glance and I realised that it wasn't going to be a simple question of taking the roof off and dragging him out. There would have to be pieces of metal bent against their natural direction, some cut away all together, before we could even begin to think about getting him out of the car. 

And all the while, the rain continues to fall. 

"You must be getting soaked out there!" said Terry, talking through a misty oxygen mask. 

"Drenched to my core, but I'll worry about that later." 

At least he was in fairly good spirits. 

"Have you got any pain anywhere?" 

"Just my legs, but that's probably because they're wearing part of the engine." 

"No pins and needles, no pain anywhere else?"

"Nope. Nothing at all." 

"That's good. Can you move your toes for me?" 

Terry tells me that he's following my instructions, but his toes don't seem to move. Maybe I just can't see properly, but in any case, there's not much I can do about it.

"OK, we'll check on you a bit more once we've got you out of there." 

It took almost two hours of the fire brigade cutting, stretching and bending metal to get Terry free. In the meantime, we did what we could; gave him fluids and pain relief to keep him stable and comfortable. He finally appeared, borne out of his car on a flat, rigid rescue board. One look at his legs was all it took to see that they were both broken below the knee. 

"Can I just see the car before you take me away?" 

"Well, not really. It's the other side of the ambulance and you're now joining the wet-suit brigade. Besides, I think you need to get to hospital." 

Terry looked disappointed. 

"I'll tell you what - let's get you inside and out of this tropical downpour, and I'll go and take a photo for you on my phone." 

"Sounds like a plan to me!" 

We moved the trolley inside, turn the heating onto the highest level and my crew mate checked him out from top to toe again. I ran outside into the pouring rain, took a photograph as promised, and ran back inside into the dry.

"So, you sure you want to see this?" 

"You bet. Might as well have nightmares about something I've seen, rather than something I've imagined." 

"Alright then, here you go." 

With his head strapped to the board and stuck between two head-blocks, only his eyes moved. 

"Well, it's taken me twenty years!"

"First accident in twenty years?" 

"No. Third actually." 

"So what's taken you twenty years?" 

"Well, I've always wanted a convertible. I just thought I'd pick better weather to put the roof down." 

Eight Miles

The radio vibrates against my shirt, the phone beeps in my pocket and I run back to the car to see the screen flash up a new call. Eight miles isn't all that far, particularly at night, but even at an average of sixty miles an hour, it will take eight minutes to get there. To average sixty, I need to be going ninety for at least some of it. In London, even at night, it's barely possible and for the most part unsafe. Unsafe for me, unsafe for pedestrians, unsafe for other motorists, unsafe for my patient if I never make it to where they are.

Eight minutes is a long time to wait for an ambulance. I know. I've been there. I've had to make that call, had to wait that wait, watching and worrying. I understand. And I want you to know that when I have to travel that far with the screen shouting at me that someone isn't breathing, or someone is seriously injured, I feel the same as you do.

The trepidation that ninety miles an hour just isn't quick enough. The worry that eight miles is just one mile too far. The feeling that each and every speed bump in the road that's meant to slow me down and as I encounter it makes the patient's chance just a little worse. If I could somehow jump over those bumps, skip around the width restrictions, fly over the cars that block my path, I would. But I can't.

The address is eight miles away, 8.2 to be exact. The junction of two suburban streets is also the meeting point for a car and the bicycle carrying Hayley on her early-morning paper round. At six in the morning, traffic is starting to build and people city-wide are starting to consider their commute to work, just as I start to see the light at the end of the shift.

The caller is the car driver, distraught, distressed, disturbed. Scared not so much of the long term consequences, but more of the immediate danger to Hayley as she lies unconscious in the road. The call-taker gives some basic instructions, to check the airway, the breathing. Not to move the patient, but to wait for the crews to turn up.

We arrive on scene together, two of them in the ambulance and me in the car. 

"Six miles we've had to run for this!" says the frustrated attendant as he grabs another bag out of the side cupboard.

"Tell me about it. I ran eight."

One look at Hayley tells us we're going to need some extra help. She's starting to come round, moaning in pain and confusion. A large, dark patch is slowly spreading across her jeans from just above her knee. Her femur, the thigh bone, is clearly broken, the angle of her leg telling us more than we needed to know.

"I'll get HEMS running. I think we're going to need more pain relief than we can give her."

"Good idea. Bet they have further to run than we did."

During the hours of darkness, HEMS teams travel by car, leaving the helicopter to a better night's rest than most of the people who work on it during the day. It takes them some time to get to us, by which time we've tried to stabilise Hayley as much as possible. I give her a strong dose of Morphine, hoping to reduce the pain at least a little, at least enough to let us straighten her leg. It's not enough. Even doubling the dose to the maximum we're allowed to give doesn't allow us to move Hayley's shattered leg at all. HEMS arrive and the doctor on board gives Hayley some ketamine, finally relaxing her into a state where we can pull the jigsaw-puzzle femur straight enough.

We finally settle her on the stretcher, the minimal warmth of the blood-soaked blankets now assisted by the heater in the back of the ambulance. Hayley is well looked after - a couple of paramedics, a doctor, a mother who ran frantically to the scene when she finally heard what had happened. It leaves me with nothing to do but to clear up the scene as much as I can without upsetting the police.

I sit in the car and watch the clock tick over to the end of the shift. The tail-lift is raised and the back door is shut, the blue lights start to flash and the ambulance pulls away with its injured cargo, leaving me to wonder if we had done all we could, if it would be enough. I start the engine and begin my journey back. 

It's a lonely, subdued eight miles. 

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?" 

Familiar Arms

Wrapped in blankets almost up to her eyes, Liana's barely visible. Naz, her husband, met us at the door with a roll of the eyes, as if to say here we go again. It takes a few minutes before we coax the first words out of her and longer still until we could calm her breathing enough to be able to have a conversation. A little boy of about three, a mix of Middle Eastern features and Eastern European pallor, runs around the house without a care in the world. Every few minutes he would come back in to check on what was happening and satisfied that there was nothing untoward, would go back to playing.

Naz never left the room for more than a few seconds at a time. He stood by the door, watching our every move, listening to every word. 

"Is Liana on any medication?" I ask him. 

"Only some painkillers when she needs them." 

"Do you have the packet?"

"I'll go and find it." 

The moment he leaves, Liana moves the blankets a little away from her face. 

"Liana, do you want to tell us what's wrong? What's got you so upset?" 

She shakes her head so violently that the straight-flowing tears suddenly zigzag their way down her cheeks. But she can't bring herself to say it. She just looks in the direction of the door and a shiver runs through her. When Naz comes back, I suggest that we need to do some more checks in the ambulance.

"I'll come with you." It's a demand rather than a request.

"Why don't you stay here with the little one, we'll just be a few minutes, do a few checks, then we can decide what the best plan is." 

Reluctantly, he agrees, but tells us he would just get their son ready and then he would be down too. In the time it takes him to find coats and shoes, we've already got half a story and realise that we need to get Liana away from home. She told us a little of the terror she faces at home every day, how she's not allowed friends, how her family have been kept away, how the threats of harming their child make sure she's kept on a short leash. Before she can tell us any more, the door to the ambulance swings open and Liana jumps in fear.

"Well, what are you doing with her? She doesn't need hospital, you know. She just needs to get back home and calm down. She's always doing this." 

"Where's your boy?" 

He shuffles slightly aside to show us a frightened shell of a child, totally different from the one we met upstairs. 

"I think we need to take Liana to hospital. Her pulse and blood pressure are a little concerning, so we want a doctor to look at her." It's a white lie, one we hoped was real enough for him to accept. 

"You're sure, yes?" 

"I'm sure." 

"Can I come with you?" 

"Why don't you come in your car, then you've got a way of coming home?" 

"Fine. But I don't want this child crying all the way there. You can take him too." 

"Not a problem. We'll look after them both. We're only going to the nearest hospital."

"I'll be a few minutes behind you. I go to the emergency department?" 

"Indeed." 

For the few minutes in the ambulance, Liana was silent. Her little boy had calmed down a little, a combination of glove balloons and a bottle of bubbles easing his fears. He even managed a laugh when one of the bubbles flew up to the roof of the ambulance, drifted slowly down and suddenly popped on his nose. As we arrive at the hospital, an all too familiar queue appears in front of us, with two other crews and their patients waiting for triage. It gives us some more time to talk, but Liana chooses to keep quiet. 

As we reach the front of the line, I have one final chance. 

"Has he ever hit you?" 

A single tear escapes and rolls down her face, as a confused little boy wipes it away for her. She leans forward, kisses him on the head and lifts the back of her shirt. She's black and blue from top to bottom. Belt marks, cigarette burns and crude, jagged cuts cover her entire back. 

"Please don't tell anyone. Please!" Her plea is barely audible, no more than a tormented whisper.

"Liana, I don't have a choice. Some of these wounds need treatment. I have to tell the nurse."

After more tears and pleads, once we promise that both she and her little boy will be looked after, she finally agrees. Having waited almost half an hour, we hand over just as Naz walks into the department and immediately all the eyes turn on him. 

"You told them, didn't you? I told you what would happen if you told anyone!" His screams make every other person in the department turn around and make me clutch on to the little boy. "What are you all looking at? She deserved it!" 

A security guard hurries over and after a bit of a struggle promptly removes Naz from the department, all the while calling for police over the radio. Liana breathes a sigh of relief and holds on tightly to her little boy who I've handed back into familiar arms.

The Secret of Medicine

Ah, the joys of plagiarism. 

"Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better. The human body is exquisitely talented at healing.  If bodies didn’t heal by themselves, we’d be up the creek. Even in an Intensive Care Unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you gave it plenty of gas, oil and brake fluid, and then expect the transmission to  fix itself."

What a fabulous paragraph, even if the article is a couple of years old. Click on the quote above to read the rest of the article by Dr. Thomas A. Doyle. No, I don't know who he is or anything about him either, except for the bit of blurb at the end of the article. But he has some very interesting things to say, don't you think? 

Change "America" for "UK", or anywhere else in the developed world, and I suspect that the same problems are present all over. 

So what do you think? Does he have a point? Are we really a nation of wimps? More to the point, does the medical system here just pander to too much? 

Case in point, particularly after the weekend just gone - The Booze Bus. Look at the photo. A transport ambulance, with a fully trained paramedic crew, loaded with three (that I can see, anyway) people who have nothing wrong with them other than an under-developed sense of responsibility and self-awareness. Should the health system really be paying for what is no more than a babysitting service for people who, a few years ago, would have spent the night in a police cell and woken up to a hangover, a steel door, a charge of drunk and incapable, and a large fine? Nothing's changed since then, except for the fear of litigation, and that in itself is well on its way to bankrupting our health system. 

I know the arguments for and against the concept of the Booze Bus (or, Alternative Response Vehicle, to give it its official title). I understand both sides, and I know that had it have been available last night around where I was working, I would have had four fewer patients. Or at least different ones. But I still feel that society as a whole needs to realise that the days of personal responsibility need to return, that the pot of money is not unlimited, and that sooner or later, whether we like it or not, charges will have to be made on certain categories of patients. I just think that the Booze Bus is as good a place as any to start. 

Picture on the Wall

A smiling face adorns the walls,
in frames all shapes and sizes,
Holding trophies, hugging dad,
bringing home surprises.

A quick look round the house again,
whilst clearing up the mess,
Certificates of excellence,
no signs of any stress.

Yet here we are, police are too,
looking at the rope.
That piece of ragged, torn up towel
that's stolen all your hope.

Your smiling face, a child so proud,
watched us as we tried.
Tried to save your dying dad,
'Til that silent face then cried.

I never met you, little one,
but know one thing for sure.
We tried our hardest, tried it all,
until there was no more.

All that pride there in your eyes,
as you stand with your team.
Your face will stay there, in my mind,

play havoc in my dreams.

I'd hate to see those eyes go dim,
I'd hate to see those tears.
Just to imagine your heart break,
brings out my deepest fears.

Your smiling face adorns the walls,
despite the sight so grim.
I'm sorry we weren't good enough,
to give you back to him.

Silence

Two faces in the dead of night, staring out of the front windscreen of a destroyed car. One's talking to me,  bragging, apologising, part regaling in their achievements, part regretting their actions. He tells me of their drink fuelled night, how they argued over who would drive, how they agreed that they'd have one go each at making the car fly over the bridge. His friend is quiet, eyes staring into the distance.

They succeeded. The police estimated that they must have been driving at over a hundred miles an hour when they hit the brow of the hill. The car's front was unrecognisable, make and model only clear from the back, airbags deployed all around. As we strap him down to a board, hoping to prevent any further injury, he tells us that once they'd left the road, the car just seemed to fly sideways instead of straight, and there was nothing they could do. In the meantime, the police dealt with his friend.

He kept saying that he wasn't brave enough to drive that fast, and when they failed the first time, they turned around, lined up again, changed seats, and had another go. He talked to us all the way to hospital, barely noticing any checks we did, any treatments we provided, just boasting about their tricks, about how impressed he was with his friend, the one we'd left on scene.

"Car's a write-off, isn't it?"

"I'd guess so."

"How come you guys got me out first? Is it because I was making so much noise?"

"Something like that, yeah."

"Well, my leg is smashed, isn't it?" It was. 

"Guess my mate's OK then, he didn't seem too hurt, just sitting back like that in his chair." 

A police officer travelling with us shuffles uncomfortably in his seat, and gives me a quick look. He makes a few more notes in his pocket book, checks once more for our call sign, and asks the passenger again what happened. He goes through the stories again, tells how they took a longer run up the second time round, makes sure that we know that he wasn't driving, that his friend was.

"I was in the driver's seat first time, but we didn't take off. So he took over. Called me all sorts of things for chickening out. But he did it! It was so cool! Shame we hit that fence though, won't be able to do it in that car again!"

It wasn't the fence that was the problem. It was the street light after the fence, the one that had smashed through the roof and the windscreen of the car. On the driver's side. The passenger, our patient, notices the looks, senses the unease. 

"Is my friend OK? Is there another ambulance looking after him? How come you didn't get him out too?" His world crashes in around him as the reality dawns, and he shouts. "I asked you, is he OK?"

I look across at the officer, who gives me an almost imperceptible nod of the head. 

"No. He's not OK. He's dead." 

Suddenly, silence engulfs the ambulance. 

Images

When insomnia seems a blessing rather than a curse, I know that it's time to take a break. When sleeping leads to dreams, nightmares, that wake me up, sometimes it's better just to stay awake. It's then that I know that I need to step away, albeit briefly. For some reason, working the day (well, two nights) of the strike last week, led me to exactly that point.

Working those shifts led to a torrent of emotions, from fear to pride, from anxiety to hatred, from fulfilment to total despair. Finishing my shift on the morning after, I got home and was ready to throw my uniform away for good. I was exhausted and frustrated, and calls that I would normally deal with on a regular basis, and that would have no lasting effects on me, suddenly turned into difficult calls. I heard of other calls that night, calls that I thank my lucky stars that I didn't attend but that colleagues, friends of mine did, because I think that having to deal with those calls as well, would have left me a broken shell. It seems that the world was going all out to make it as difficult as possible to do our job. Fewer ambulances, more calls, more serious calls. 

And I left work that night with the image of a smiling child burnt into my mind. A picture that was hanging on a wall. A child, no older than my youngest, with a grin like a Cheshire cat, holding a trophy, beaming with pride.  That child was about to have their world crumble all around them, as soon as the police had done their job - a job I didn't envy one little bit. 

It all conspired to leave me wondering whether it was all worth it, with what the police officer in the blog I've linked to refers to as an involuntary slide show. The politics, the trauma, the arguments, the abuse, the emotions. I had to step away, just for a few days. Not read any blogs or write them, not think about the ambulance service, not talk about it, not consider the possibility of working some overtime. I had to spend some time with friends and family, some time not seeing things in perspective, but seeing them through slightly rose-tinted glasses. 

The image of that child will, I'm sure, stay with me, even though I never met them in person. One day, I might write about the call itself, but not yet. For now, I'm ready to go back to work, if a little anxious. The tensions of the strike are no longer there, everyone is just there to do what we do best: saving people's lives. Or at the very least, improving them. 

Putting Their Lives on the Line

I was at home enjoying some family time when it happened. But just hours after the horrendous incident in north-west London that left four police officers with serious injuries after being stabbed, I was back on duty, and this time, not a million miles away from the scene.

At a totally unrelated call, an RTC, the police had to block the road for a few minutes so that we could treat our patient safely. A driver caught up in the traffic approached one of the officers, stood toe-to-toe, and through gritted teeth and a with a horrible snarl commented: "It's no wonder you lot get stabbed."

I'm not sure I would have been as restrained as this officer was.

The police have to put up with a lot more abuse than we do, and take greater risks too. If there's a call that sounds a little suspect, we'll ask for police attendance and hide around the corner until we know it's safe. Yesterday's incident proves once again how big that risk often is. I have a great deal of respect and admiration for the police, what they do, and what they sometimes have to put up with, especially as they've saved me from a serious pounding on numerous occasions.

I hope and pray that those injured make a full and speedy recovery, both of body and soul. They deserve it.

And as far as the idiot driver who had been inconvenienced for a few minutes, well, I can't really tell you what I hope and pray for him. But I'm sure you can well imagine.

Thursdays

Lying on the pavement in a puddle which I hope is just rain, but fear that it probably isn't, Val starts cursing the second he sees me approach. 

"Now, now, there's no need for that! We should be best friends by now!"

"Oh! I'm sorry." Val says. "I didn't know it was you. I thought it was the old bill again."

Somehow his clothes are filthy, even though I remember for certain that they're not the ones he was wearing the day before. He's a regular, but as regulars go, normally a fairly friendly one just looking for somewhere warm to spend the night. The truth is, it's rarely Val that calls us, but some unsuspecting member of the public worried that they're looking at a dead body in the street. So far, he's never been dead. I fear for the day when he really is, it'll probably be the one time that nobody bothers to call. Along with the rest of the usual observations, I check his temperature which shows that he's hypothermic, four degrees below the normal body temperature. 

"How long have you been out here?"

"Don't know, what time is it?" 

"About eleven o'clock." 

"At night?"

"It's dark, isn't it?" 

"True, but it could have just been cloudy." I raised an eyebrow, and he saw the flaw in his own logic. "Anyway, if it's eleven, it's probably been about eight hours. I got thrown out the pub at about seven." 

"That would make it only four hours, Val." Unsure as to whether it's alcohol or hypothermia that's causing his confusion, I decide on another line of questioning. He wasn't sure where he was or which pub he'd been in, but knew his date of birth and even where he was born, or at least claimed to have been. With time for one final question as the ambulance pulled into view, I decided on an easy one. 

"Do you know what day it is?" 

"Pass me the bag will you?" Val takes the plastic bag, pulls out the large bottle of cider, turns the label towards him to read the name and proudly announces: "It's Thursday. I always drink this one on Thursdays." 

Oil Spill

Monday morning. 

Early. 

As the world begins its weekly ritual, a few tired night workers are preparing for their midweek weekend. Empty milk floats head back to their depots, their early morning rounds completed, many a front doorstep adorned with their goods. Autumnal sunrise greets the early risers, the sun shedding plenty of light but not yet enough warmth to clear the dew from the grass and the roads. 

Mike is one of the masses, joining the rat-race and heading into work. In an effort to make his journey easier and quicker, he abandoned his car in favour of two wheels. For months, he'd enjoyed the fact that he could cut through London's standstill rush hour, leave home a little later, arrive back a little earlier, adding a few precious extra minutes with his family every day. 

The call on the screen brings back memories, ones that I'm not keen to relive. Motorcycle under a van, status of patient unknown. When the call comes in, I'd just finished dealing with an acute case of probable paediatric schoolitis, a common childhood ailment, regularly apparent on Monday mornings. There were twenty minutes left of the shift. The call was some five miles away, and would take me straight past the front door of the station, frustratingly close, yet so desperately far. My relief was probably already there drinking coffee and awaiting my return. A few minutes later, Mike and I meet for the first time. 

Unlike the call I'd feared, Mike's head was visible, and he was actually sitting up, helmet off, and talking quite happily. His right leg, however, is wedged between the two back wheels of the van. His bike is lying on its side in front of the van, smashed shards of shimmering glass mingling on the road and glistening in the sunlight. Just in front of that is a small pile of powder covering what we presume is some oil on the road. 

"I don't really remember what happened, I just lost it on the wet road I think. Next thing I know, there's a van on top of me!" 

A quick conversation with the van driver gives us a few more clues and leads us to believe that Mike's had his leg run over by both the front and the first of the back wheels, with the van coming to a halt before the third wheel added insult to injury. 

Unsure of the exact circumstances, Mike's neck is immobilised in a collar and he's laid flat. The fire brigade, having arrived a few minutes later, have secured the van and lifted it high enough for us to get to see Mike's leg. His leathers are intact with only a few scuff marks, but his foot is lying at an unnatural angle, giving away the secret hidden beneath the leathers. As we cut the trouser leg away, the damage is obvious. Several breaks, the worst at the ankle. 

As usual, several things happen at once. A cannula is placed in Mike's arm, giving easy access for some pain relief. A scoop stretcher is placed under him, ready to move as soon as he is secured. Some bandages and a splint are applied to his leg. All while someone else checks for any other injuries, and luckily, finds none.

In the ambulance, once Mike was settled and his pain controlled enough, there are a few moments for a quick conversation.  

"I think you might have slipped on some oil, or diesel. There's a patch already covered up with some gravel, just by where you came off your bike!" 

"You talking about the white grit-like stuff?" 

"Yeah, that's it. Someone must have put it there not long before, it still looked quite clean." 

"Ah. That's not grit or gravel." 

"How do you know that?"

"Well, I work for a pet shop." 

"And?" 

"Well, I was on my way to work with a big bag of cat litter hanging off the handlebar..." 

Street Lights

The street lights off,

the normal orange glow replaced 

by the flashing blue lights of the police. 

They wave, the officers,

an unnecessary, well-meaning gesture 

to show me the way. 

They turn both their torches downwards

towards the floor,  

and look down, their heads bent 

as if in prayer.

She lies there, a mass of displaced, 

broken bones, 

a mangled, tangled mess, 

limbs misshapen, 

arms and legs scarred,

outstretched. 

She stares, in silence, directly upwards,

past the darkened street lights,

past the trees, 

past the broken, open window, 

past the clouds. 

The sky responds, sheds tears of its own, 

and washes away the blood, the hurt, 

the pain. 

Nurse In Charge

The nurse in charge sees us walking Martha into the department. 

"Stop right there!" She shouts. "She's not coming in here unless she's been searched!" 

Back at Martha's house, we had spent an hour negotiating with her, at first through a closed door, and then, finally, face to face after she agreed to let us in. She seemed pleased with her achievements, proudly listing the cocktail of drugs and alcohol that she'd ingested over the previous hour or two. If what she told us was accurate, or even close to it, she would need some serious medical attention, and quickly. 

"Of course she's been searched. The police even stopped her bringing a large kitchen knife with her." 

As we were about to leave, Martha asked if she could go back to the kitchen to get her packet of cigarettes. I waited by the front door as a police officer accompanied her back into the house. Suddenly, he shouted at her to "Put that down!" at which point I saw Martha return a knife to the kitchen drawer. Grinning manically, she put the cigarettes in her hand bag, and we all made our way to the ambulance.

"I don't care. She's not coming in here until she's searched again. Check everything and everywhere. Last time, she'd hidden a knife in her boot." I looked again. She was wearing knee-high boots over a pair of jeans. The two officers who had accompanied us looked at each other, and then at Martha. We all moved into a side room, the eagle-eyed nurse in charge watching every move. 

As she was searched again, Martha started a search of her own. 

"Where's my handbag?" 

I had a quick glance around the room and just outside too. The bag was nowhere to be seen. 

"Must still be in the ambulance. I'll go get it."

The handbag had been in the kitchen, the cigarettes were shoved inside, and Martha had turned her back to us for a second to pick up a lighter too. "No point having ciggies and no fire to light 'em with!" she'd said at the time. "You coppers need to lighten up a little!"


I think that all men struggle to know what to do when asked to hold a lady's handbag. We struggle to look at ease, for fear of looking, too, well, at ease, really. I walked back in to the department, looking and feeling a little uncomfortable, clutching the handbag at the top and letting the handles hang loose by the sides. Stepping back in to the side room, I attempt to hand the bag back to Martha.

"Oh. No. You. Don't... Not. Before. It's searched!" The emphasis of every word, every syllable did the trick, and I gave the bag to the officer. He opened it up, and blue-gloved hands rummaged through the contents. There were dozens of pieces of paper, chocolate wrappers, lipsticks, a packet of cigarettes and lighter. Right at the bottom, hidden by everything that had been thrown on top, was a serrated kitchen knife, with a six inch blade.

"And that, ladies and gentlemen, is why I'm in charge, and Martha isn't."

And to think how close I was to that knife, all the way to hospital...

Movies

The feet appeared first, his legs skewed apart

mimicking the lines they draw in the movies.

His upper body hidden from view, the suspense building, 

following a plot like the movies.

Climbing over a table to see blood spattered walls,

and a gun lying spent on the floor. 

Finding him there, motionless, lifeless. 

Faceless.

Looking for some way to help. 

Finding none. 

Realising that this isn't the movies. 

And knowing, again, that happily-ever-after 

is often nothing more than a movie, a wish, a dream. 

The Other Leg

Late evening in the city, where another weekend heads to a close as the world prepares to face another Monday morning. There's a definite chill in the air, a disappointing summer fizzling out as the nights begin to draw in, yet all around people are spilling out of pubs and clubs wearing no more than the bare essentials. The street sweepers are out in force, one of them earning a torrent of verbal abuse for daring to complain to yet another youth for throwing an empty cup on the floor.

Rash and his friends walk away laughing, alcohol and bravado fueling yet more antics until, suddenly, he loses his footing on the edge of the kerb. His leg twists, snaps and gives way, and he crumples in a heap on the floor. The street sweeper sees it happen, yells something about karma and walks away to continue his never-ending litter hunt. 

We're dealing with a drunk no more than ten paces away, another victim of just having a good time and she doesn't usually get like this. Each of us, Dean and I, has one eye on our patient making sure we don't get covered in vomit, and another on the altercation, looking for signs of a fight breaking out. When Rash falls, we're close enough that we see his leg change direction and clearly hear the crack in the bone. 

"Stay there!" I shout. "We're coming." Dean calls for help, asking for a second ambulance.

Unable to move even if he wanted to, Rash lies on the ground screaming in pain. Two police officers patrolling the area hear the noise, which even in the bustling surroundings was out of the ordinary, and come to investigate. The bad timing on their part means they get to stay with the vomiting drunk and her overly exuberant friend.

Dean brings the trolley bed and a splint over, the need to see the injury first seeming superfluous having witnessed the noise it made. Nevertheless, a pair of shears always beats a pair of jeans in the trauma version of "rock, paper, scissors" (where the rock or paper are any item of clothing which may be hiding any part of the anatomy that needs to be viewed directly, in a hurry and with a minimum of movement), and seconds later Rash sees his leg for the first time since getting dressed earlier in the evening. He looks down at his ankle, and instantly looks away.

"Do you think it's broken?" It's more of a last gasp attempt at denying what he already knows than a real question.

"Well, I think the fact that your foot is facing the wrong way and there are two bones sticking out of your ankle would probably confirm that." Ten paces away, as if on cue, our drunken patient vomits for the umpteenth time. One of the police officers sends us a grateful stare, all the more grateful now that another ambulance has arrived to deal with her.

We load Rash into the ambulance, dose him up with some pain relief, and straighten his leg out as much as possible before heading to the nearest hospital. The screams of pain as we pull his leg straight subside once his foots faces front again, entonox and morphine leaving him a little dazed. When I ask his date of birth, he hesitates, looking at his friend for guidance. A shrug of the shoulders was the only reply.

"How old are you Rash?"

"Nineteen."

"And what's your date of birth?"

He tells me a day and a month without hesitation, but when it comes to the year, all he could say was "Ummm..."

"OK, so how old are you really?"

"Sixteen. And a half." And a half. Of course. That makes all the difference.

"And why didn't you want us to know that?"

"I didn't want those coppers to arrest me again. You know, for being drunk under age and all that."

"What do you mean arrest you again?"

"Well, I've already been arrested five times before. I was twelve the first time!" He high-fives his friend, seemingly proud of his criminal record.

"Twelve? What were you arrested for at twelve?"

"Fighting!" Another laugh, and another high-five.

"And you were twelve?"

"Yeah man. I've still got the scars now!"

"And you're proud of that?"

"Well, yeah, why not? But not as proud as I am of something else." He shoots his friend a knowing look, and they both smile.

"What's that, Rash?"

He pulls up his other trouser leg and proudly shows off his electronic tag. "Got this last month, didn't I! All my mates want one now, it's, like, so cool!"

"You know that you'll probably get nicked now anyway, out after what I presume is your curfew time?"

"Oh what? Even if I'm in hospital? Pull the other one, yeah?"

"I already did." 

S'pose

"I know you," he says, his knock on the window jolting me out of my nocturnal daydream. "You picked me up when them cops came to my house! S'pose you don't remember." 

"Craig?" 

"Good memory you've got there." 

"What are you doing here at four in the morning?" 

"Oh, you know. This and that. Just hanging around." 

"Outside a hospital?"

"S'pose this is where I live now. Under section, in the nut house round the back. They just let me out for a smoke, but I ran off to get a better spot." 

Craig was dragged away from home a couple of weeks earlier by the police after destroying every piece of furniture in his house and threatening to set fire to the damaged remains. His mother begged us to let him stay at home, claiming it had never happened before, that he was just drunk, and that she'd look after him now. Two facts prevented that from happening. The first was the fact that it was taking the full force of several police officers to restrain him, and the second was the arterial bleed from his arm. 

Craig went back to sitting on the wall where he must have been perched before scaring the life out of me. It was three storeys up from the ground, with nothing between him and the concrete below. 

"You know, I'm pleased you're here. You can be my witness." 

"Witness for what, Craig?" 

"For me jumping off here. You can tell them that I meant it, that I didn't just fall." 

"Jumping? What do you want to do that for?" I sat there, frantically wracking my brain for a way to get some help without alerting him to the idea, but in the meantime I was happy that he just kept talking. 

He took a crumpled cigarette out of his pocket. "I 'spose you don't smoke, do you?"

"Nope. Never have done. Why?"

"Smoked since I was fourteen. Ten years that is. S'pose I knew then already that I wasn't going to have a long life. Twenty a day normally, sometimes thirty, forty. Even had a hundred once in one day, thought it would kill me there and then, but it didn't. Still here, aren't I? Still need my smokes. Still need some fresh air to smoke 'em. Pollute the air with smoke like they tried to pollute my mind. I know what they were doing to me in there!"

"In where, Craig?"

"There! The nut house!"

Craig pulled a lighter out that was tucked into his watch strap, made himself a little more comfortable on the edge of the wall and after a few attempts finally managed to light the cigarette. Two long drags later, he kept talking.

"I'm gonna finish the pack of twenty that I've got, and then that's it. I'm getting out. I've got this one and one more. That's it. No more smokes, no more police, no more hospitals, no more nothing. Glad you're here, anyway. I already told you that, didn't I?"

"You did. But I might be gone in a minute, if I get a call."

"S'pose I'll wait 'til you get back then."

As if on cue, the computer rang and sent me out into the night, heading in the vague direction of a jumbled set of coordinates on a map. Someone had called in from a mobile phone, and before the exact details are confirmed, the system works out which mast the call is routed through, and starts sending me there. The little red triangle on the map showed a point less than a mile away. Now that I finally had the chance, I called up control and let them know about Craig, where he was sitting, and that they need to send someone, anyone, to stop him from carrying out his threat.

A minute or so down the road, the details of the call finally came through.

Location: Nearby Hospital, by the A&E entrance. 


Details: Male, unknown age, threatening to jump off high wall. Ambulance car was on scene, now left. 


By the time I'd turned round and got back to where I started, two members of staff from the Mental Health unit were talking to Craig, as a police officer helped him off the wall. He looks up at me, perhaps confused by my swift return, perhaps amused by it.

"You know what," he says, as a pair of handcuffs are applied, "I'll do it one day, whether you're there, or anyone's there. Or not. S'pose it's back to the nut house. S'pose I'd better get another packet of smokes, though."