by Wharton, Kit
Jo looks at me.
—You know you’re drinking too much, don’t you?
This is the life. Just another long, crazy shift. Ours not to reason why, ours just to bitch and moan and wonder how the hell we all ended up here. What’s the Talking Heads song? ‘Once in a Lifetime’?
And you may ask yourself:
How did I get here?
2
Communication
I joined the ambulance service in 2003 because I thought it would give me the sort of job I wanted. Something where you can make a difference. I may have a low boredom threshold. The service is rarely boring.
Up to then I’d had not exactly what you’d call a successful career. I only got to university because my girlfriend dumped me and went off to university herself, so I thought I’d better do the same. But I still didn’t have much of a clue, so I followed my parents into journalism. Which I wasn’t very good at.
I started doing shifts on the diary column of a well-known paper. I was so terrified my first morning I had to drink vodka before I went in to work just so I didn’t shake too much. I was supposed to write fun snippets of news about famous people, but I didn’t know any. The first piece I wrote ended up libelling someone so badly she won undisclosed damages in the High Court. I was told ‘undisclosed’ means at least five figures.
I never went back.
I decided to play it safe and went to work on a boring magazine called Fish Trader, about people who trade in … fish. The only interesting thing about working there was that along the corridor you had other magazines with titles like Disaster Management, which sounded fun.
From there I moved to Scotland, to work on a local paper, which was more like being a proper reporter, although I couldn’t understand most of the accents. It’s difficult to quote people when you haven’t a clue what they said. Good training for talking to people in pain and distress now, though.
Then I found out my mother was dying of cancer, and that changed things.
I left to live with her back in England. She lived alone. I spent a year watching her die in front of my eyes. That was probably good training for the ambulance service too. Just before she died she said the last year of her life had been the best.
I managed to get shift work on national newspapers after that, but never really had the confidence. I could never think of ideas for news stories, and felt frightened of most of the other people in the office. All of them seemed to have gone to Oxford or Cambridge or both. Sometimes I had to take a pill just to go and talk to the news editor or pick up the phone. So I left and painted houses and moved furniture. I don’t miss journalism.
Reporting and ambulance work, asking people questions and trying to make sense of what they tell you, do have similarities. In news reporting, you’re going out to people, trying to understand what’s happened to them, and telling the readers. With ambulance work, you’ve got to find out what’s happened a bit more quickly, then do something about it. Then report to the hospital. Otherwise it’s much the same thing. Sometimes just talking to people is the most important thing.
Sometimes their lives depend on it …
Douglas
Monday morning.
I apologise to any cardiologists, doctors or paramedics reading, but I may have invented a medical procedure. Maybe.
Called to a male, sixties, chest pains.
The symptoms are classic. Crushing central chest pain, radiating into left arm and jaw. Short of breath and dizzy and pale. Needs to go to the loo, sense of doom. Textbook stuff. Douglas is a tall, quite slim gent, alone in the house and very calm and pleasant. But it looks like a heart attack, and he knows it.
After he’s been to the loo, we give him oxygen and aspirin and a spray in the mouth that takes a little of the pain away, then pop him on the carry chair and wheel him out to the ambulance. Once we’ve wired him up to the monitor, there’s little room left for doubt. His ECG has what’s known in the trade as massive ST elevation – another classic sign. At the hospital they’ll do blood tests, but basically, if it walks like a duck and talks like a duck …
The doctors can give drugs that break up the clot, or even stick a tube into his veins to suck the thing out, but at the moment it’s close to killing him.
So off to the hospital we go with lights and sirens flashing. Val’s driving.
On the way in I do my best to reassure him, which isn’t difficult. He seems quite calm and sensible. I can’t imagine that I would be, in his situation. The spray has taken away some of the pain and he can breathe better, and I think he’s gone into crisis mode – he knows exactly what’s going on, and is almost waiting to find out what’s going to happen. (I suppose it’s not much fun having a heart attack, but probably the last thing you’d call it is boring.)
Anyway, all the way in I monitor him on the ECG and keep him talking. The ST elevation is getting bigger and bigger and the heart rhythm is becoming faster and more irregular as the heart is being damaged and becoming distressed, but he’s still with us. It’s only a three-minute drive in, and we’ve phoned ahead so they know we’re coming.
We arrive at the hospital and wheel him into the resus bay (where the really ill people go), where a doctor and nurse are waiting to receive him. They both settle down either side of him, trying to get a needle into one of his veins to draw off blood and to give drugs. One’s concentrating on his left arm, the other on the right. His veins are proving difficult, so for several minutes neither of them is looking at or talking to him, and this is when a strange thing happens.
In order to explain I need to go into a bit of detail. Apologies for the ignorance of what follows. Normal healthy hearts – as I understand it – generally don’t just stop. They don’t usually go from beating happily one second to stopped the next, except in the very old. They usually, or at least often, go from a normal heart beat into one of two rhythms: ventricular tachycardia, or more commonly ventricular fibrillation. With the first the heart’s going so fast no blood gets in, so none can get pumped round the body (so you die) and with the second the heart starts jerking away in an uncoordinated fashion. Same result. Either way you’re dead. Only once you’re good and dead some time will the heart slow down and actually stop.
So often with people who’ve just ‘died’ there’s a period where their heart is doing one of the two things above. This is why people are given electric shocks. The shock will stop the heart doing either of these things above, and hopefully it will settle back to a normal rhythm.
Hey presto.
You were dead, now you’re alive.
But if you haven’t got a machine handy for giving electric shocks, a big fat punch in the chest can also do the trick. It’s called a precordial thump. The effect is the same.
What I have invented (I think) is the precordial conversation.
Back in the resus room, the doctor and nurse are still busy trying to get needles in the patient’s arms, while I’m watching the monitor. The patient’s awake, but then goes even greyer and his head slumps to one side and his eyes close. I can see on the monitor that his heart rhythm is breaking up into ventricular fibrillation. This is the point at which he’s technically dying, I suppose.
So I shout at him. Very loudly.
Something like what’s your wife’s name? He appears to wake up, shakes his head slightly, and tells me the answer. The rhythm on the monitor settles back down again.
Then a minute later, the same thing happens. He goes grey, his head slumps to one side, and the rhythm on the monitor breaks up. Dead again.
I shout at him again. Are you comfortable? Or something.
He shakes his head, wakes up, and the rhythm settles down.
Val’s cleaning the stretcher. She can’t see his face or the monitor. She gives me one of her looks. What the fuck is wrong with you?
I wonder how long we can go on like this.
—What’s your favourite colour?
—Who’s going to win the FA Cup?
&nbs
p; —Do you like ice cream?
The answer’s probably not long, but it definitely seems to work a couple of times before the doctors and nurses finish what they’re doing and they can start shouting at him and keeping him busy and not dying. So we say goodbye and wish him luck and walk out of resus and into medical history, having invented the precordial conversation.
Like I said. Maybe.
Part of the reason I failed in journalism was I was terrible at job interviews. At one I saw the news editor of a major Sunday paper on a hot August day. I began to sweat so heavily rivers were running down my face. The editor looked concerned, as if I might have malaria, and asked if I was all right. Another time I went for a job with a big charity. My research was going to the library to look them up and find out they were the largest pressure group in the UK. One of the panel was an enormously fat woman.
—What do you know about us?
—I know you’re a pressure group.
—What else?
—You’re large, I said. Very large.
Silence.
Shit.
Even with a bit of experience, in this job, it’s very easy to say the wrong thing. It’s called foot-in-mouth disease. Val’s often very helpful in pointing it out to me.
Val
When I joined the service there was a strict progression of experience before they let you loose on an emergency ambulance. (There still is.) First you did patient-transport work, ferrying people in and out of hospital for booked appointments. Then if you wanted to move to A&E you had to do a two-month course to become a trainee ambulance technician. You worked as a TAT for a year, always with someone more experienced. Then you had a two-day assessment to see what you were like, hopefully followed by qualification. After that you were let loose – allowed to work with someone who was less experienced than you.
You are in charge.
The first day of doing this – I’d been in the service about three years – was frightening. My first day in charge was a while ago now, with a trainee – Valerie. We had dead bodies both ends of the shift, my blood pressure went through the roof, but I think we got away with it.
Val’s a bit like me, falling into the service after various jobs – airline stewardess, office worker – hating them all. I think she worked in a zoo once, which she quite liked. I bet that was good training for the job.
Val and I stayed together after this, as regular crewmates, for a while. You learn to depend on each other. You end up knowing the other’s opinion on everything from Islamic fundamentalism to emulsion paint. Having a good solid crewmate’s like having a good left leg. It’s difficult without it.
Monica and Gordon
Midnight.
We’re called to a female, twenties, in labour, childbirth imminent. This is not an unusual type of call, but the next bit is. They’re in a field.
Or rather, parked beside one.
—Shit, says Val.
What’s happened is she’s gone into labour, so they’ve made a break for the hospital, but then the baby’s decided not to play ball. It’s playing I’m coming out now! The trouble is they don’t know where they are or what road they’re on, and so they’ve got right royally lost.
So we have an interesting ten minutes or so driving on blue lights up and down the road, looking for them. We come off the motorway. We go back on. No sign of them. At this rate the bloody thing will be collecting its old age pension before we find them.
Eventually, from up on the motorway, we see the van in the moonlight, hazards on, out in the country in the middle of nowhere. Five minutes later we pull up behind. Inside the scene is … novel. Mum is a young girl, naked from the waist down. She’s already given birth while driving along, and the poor sausage has fallen out and landed in a heap in the footwell of the van before they even had time to stop. There’s what looks like a massive Irish Wolfhound, or maybe a small horse, going bonkers in the back.
—Woof!
The whole inside is filthy. It’s obviously a well-used vehicle, an old camper van, and hasn’t been cleaned or tidied in years. Mud everywhere. Baby’s now wrapped up in an old towel which doesn’t look too clean either and is being cuddled by Mum.
The problem is the placenta hasn’t been delivered yet, and we need to get Mum out and on to the ambulance, and the baby properly wrapped up in something that doesn’t look like it’s used to dry off the beast in the back. Luckily the police have arrived behind us, so they close off the road, so that we can draw alongside, and they hold up a blanket while we get the stretcher out and get Mum and baby on board. Not that there’s anyone around here, anyway.
I go round to tell the person sitting in the van with her what we’re going to do. He’s an old man, maybe sixty or seventy, and looks Middle-eastern. Balding but with a pony tail. Maybe he’s her father? He can hardly hear me over the dog.
—Woof!
—Are you a relative?
—I’m the father.
—Her father?
—No, the baby’s father.
—Woof!
Shit.
Brilliant. Val mouths at me. Fantastic. Well done.
I’ve put my foot in it. Not for the first time. Oh well. Never mind.
As we get her on board and he follows us into the hospital, it’s the elephant in the room – or ambulance – all the way in. We try and give the midwives a bit of a discreet warning so they don’t blow their own feet off like I did, but it’s difficult. Funny old world.
Funny very old world.
Mum and baby are doing fine when Dad arrives, thankfully dogless, shuffling in looking confused, every inch the mad professor. The midwives make everyone comfortable and test the newborn to make sure it hasn’t suffered from the unscheduled rolling around on the filthy floor.
My crewmate and I wish them all well and leave, wondering how soon we’ll be back out to him with dementia or something.
The interview with my boss Len for the ambulance service was pretty successful, compared with the charity fiasco. For some reason I didn’t feel so nervous. Maybe I knew I wanted the job. Or that I might be OK at it.
Did I mind blood, vomit, faeces? Was I hard-working? Did I like people?
No, no, no, yes, yes.
Was I reliable and good in a crisis?
Yes and maybe.
Did I have any unsightly or offensive tattoos?
I looked at his arms, covered in tattoos from elbow to wrist.
No, but I can get some if you want.
It was pretty much the only time I had ever seen him laugh.
Silly bastard.
I was in.
So that’s how I started.
The service itself started earlier. Wikipedia will tell you the first recorded ambulance was a hammock-based cart affair ferrying around leprosy and psychiatric patients a thousand years ago. Presumably everyone else had to walk. The first emergency ambulances were used by the Spanish 500 or so years later, and London had a civilian service for cholera patients a few hundred years after that. All pulled by horses or people. Then late in the nineteenth century came the first motor ambulances, before Ernest Hemingway hit the PR button with A Farewell to Arms.
Only in the 1950s, though, did the emphasis shift from regarding ambulances as means of transporting patients to mobile hospitals for treating them. Since then the pace has hotted up. Equipment and procedures change almost by the year, reflecting changes in medical thinking.
But one thing never changes. There’s always a form to fill out. Paperwork.
There are forms for every patient. If they don’t go to hospital, another one. If they’re septic, another. If they’ve died, another. I have a joke if patients are not sure they want to go to hospital.
—Let’s do the paperwork; then we’ll both have died of old age.
And there’s an endless variety of jobs. An endless variety of things that can go wrong in this life.
Where else could you take two people into the hospital on the same shift? One who�
�s suffered a cardiac arrest while driving and crashed into a building. We got him back. (Good job, said Len.) The other who’s fainted, frightened he was allergic to his cheese and onion sandwich.
(For fuck’s sake, said Len.)
One of the reasons I like the Health Service is I always wanted to be a comedian. This isn’t as strange as it sounds. My oldest friend used to run comedy clubs all over the place, and I used to help out on the door taking money. This was back in the nineties. A lot of people who would become household names performed. I used to yearn to have the bottle to get up on the stage and make people laugh, but I never did. In the ambulance service you can step on and off the stage whenever you like. You can be funny when you need to be, and serious when you don’t. A lot of times when people phone 999, they want someone to come along and take charge of a bad situation, not panic, and make it better. An amazing number of times, a joke succeeds in all three.
—Haven’t I seen your face before?
—Yes, on Crimewatch.
Or:
—You’re a smooth driver.
—I’m even better when I’ve sobered up.
Or:
—I was in hospital last week with me legs.
—Better than being in there without them.
That sort of thing. You sort of have to be there, but they do work. And obviously we’ve got bandages and drugs and oxygen and stuff for when a joke isn’t quite enough. One of the things you learn is when to make the joke and when not to. Sometimes Val gives me a look.
It’s time you shut up now.
You can’t make a joke out of everything.
And it has to be said, sometimes it’s the patients who say the funniest things.
Kenny
Another shift with Val.
We’re called to a man, fifties, outside his flat in town. He’s a known self-harmer and he’s cut his neck.
So far, doesn’t sound too exciting. We go out to a lot of self-harmers and they don’t usually do too much damage. Usually just cuts and scratches deep enough to show a little blood and let the pain out, as one of them once told me.
