by Wharton, Kit
But this guy’s a little different. When we get there there’s a very worried-looking copper holding a dressing to the man’s neck. The patient is sitting on the pavement with his back against the wall. His face is white in the darkness and he’s wearing a dark red tracksuit.
Only it’s not a dark red tracksuit. It’s a white tracksuit, absolutely covered in blood. Soaked. He’s sitting in a pool of it.
Blimey, we think, and switch into hurry-up mode.
The patient’s still conscious and breathing, and he hasn’t actually cut his own throat, so he’s still able to breathe. But he’s very close to fainting because his blood pressure’s collapsed due to the fact he’s sitting in most of it. We get him on some oxygen and onto a stretcher with his feet raised so what little blood’s left goes to his head where it’s needed. A paramedic who’s backing us up gets a line and some fluids in him with difficulty and we relieve the poor copper, also looking rather pale, and get a new dressing on his neck. Then it’s off to hospital.
—What the bloody hell happened?
Kenny has a history of depression, alcohol dependence and self-harm, and often cuts his arms or neck with a Stanley knife, but like most people just makes small cuts. Tonight he was (sort of) happily cutting away at the side of his neck when he realised things had gone too far and the blood’s pissing out like a tap. He staggers out into the street and calls 999. A bit of a shock really, but maybe the brush with death will do him some good. Shake something up in his head.
I can’t help thinking despite the self-harm, alcoholism and depression, he’s still something of an optimist. He’s unemployed, wearing a filthy old tracksuit drenched in blood, and he’s got a drink problem. Val’s in the back with him. She’s young and beautiful and professional, and he doesn’t know about the bad language.
—You going out with anyone? he asks on the way into hospital with the blue lights flashing.
—No, not at the moment.
—Would you go out with me?
—Well, let’s get you to the hospital and sorted out first, shall we? Then we’ll see.
At hospital Fatima manages to look expressionless and mystified at the same time. I think she often finds us – patients and ambulance staff – strange.
—He cut his own throat?
—Yes.
Unwell patient.
3
Frequent Flyers
Friday evening – years ago. I’m petrified, as frightened as I’ve ever been in my life. I joined the ambulance service eighteen months ago, and now it’s my first-ever shift on a proper, front-line, A&E, emergency ambulance. Tonight, real people – the poor sods – will depend on me to look after them; their lives will be in my hands. I can’t quite believe it – why did I ever sign up to this?
Fuck!
Anyway, I’m crewed up with a nice experienced woman, Denise, who no doubt will look after me, but it’s still terrifying. I’ve opted to attend for the first six hours of the shift – best to get it over with – so I’ll be in the back with the patients. Oh my God. We sign on and the shift starts at 7 o’clock, and after that we’re just waiting for the first job.
I’m shitting myself.
Nothing happens for the first half an hour, and this even makes it worse. Denise sits watching EastEnders or something, perfectly calm, she’s seen it all before. I sit watching the screen but taking nothing in, trying to stop my heart hammering away. And then it happens. Our pagers go off and we have a job. I jump up and get in the ambulance, wondering if I’ll have a heart attack or throw up first.
Billy
Halfway to the scene the details of the job come over. Male, forties, blood gushing from ear. Conscious and breathing.
Jesus Christ, I think, what’s this? ‘Blood gushing from his ear’? What from? An injury? Assault? A cerebral bleed? Bloody hell. What on earth do I do?
Denise remains icily calm and says nothing as the blue lights flash and she drives to the job, which has been called in from a phone box in the town centre. Then we see the call box with the caller still in it. All she does is sigh quietly.
—It’s Billy Watts.
Billy Watts? Billywatts? What does that mean? A person? An illness? A condition?
I jump out and head towards the patient. He’s rough-looking, in his forties, dressed in dirty clothes, with a tiny trickle of dried blood coming from his ear – nothing else. Drunk and filthy.
I lead him to the ambulance and get him on board and wash his ear, which has a tiny scratch on it, with shaking hands and take his pulse. He doesn’t seem unwell otherwise but is obviously drunk. My crewmate looks on silently, her face a mask.
—Shall we head off? she says.
If we don’t take him to hospital now, he’ll phone back later with ‘chest pains’ or ‘suicidal thoughts’ or something. He likes going to the hospital, and he’ll keep phoning back till we take him. Might as well get it over with. This is the way it works with some people, though I don’t know this yet.
So off we go to hospital. Fatima stares at me.
—Why you bring him here? Nothing wrong with him.
It turns out he’s a regular visitor to the hospital, usually drunk, complaining of self-inflicted injuries or no injuries at all. But I’ve got him to hospital alive, and therefore done my job, and survived myself, and so we’re up and running.
I even took his blood pressure on the way in to hospital.
—You did what? Denise asks.
—I took his blood pressure.
—You bloody idiot. It’s Billy Watts. You might’ve got your stuff dirty.
That was my first A&E job. Hardly exciting.
It was still useful, though. It taught me to expect the unexpected – there’s a lot of unexpected in this job. And you learn there are a terrifying number of Billy Wattses in the world. People with little or nothing and blowing whatever they have.
People watch Holby City or Casualty and think every job is life-threatening and involves a plane crashing on to a train which ploughs into an orphanage, all on Christmas Eve. And you’re trying to do the job thinking about splitting up with your partner or having a sex change or whatever. It isn’t always like that. If it was you’d end up in a lunatic asylum. Or like Billy Watts.
In the airline trade you get people who are called ‘frequent flyers’, successful business people racking up the air miles attending conferences and going to meetings and whatnot. Successful, respectable, nice.
In the service we have frequent flyers too. But they are not always so nice. And they don’t smell quite so good. People who call 999 for the wrong reasons, or no reasons, sometimes hundreds of times.
Some are in a desperate state. Some aren’t.
Probably the most astonishing fact about the service is the degree to which it’s abused by them. Some have worked out that if certain buzz phrases are used – ‘chest pains’ or ‘short of breath’ – the service gets all Pavlovian and sends an ambulance to check them out, no matter what. Even if they’ve called hundreds of times before, this might be the one time they’re genuine. Each area has what is called its ‘regulars’ (like a pub) who sometimes call every day. I heard one elderly lady in our area had had a total of something like £400,000 worth of ambulance visits over a few years. At anything up to £400 a call-out, that means she’s called an ambulance over a thousand times. And we still go to her.
Another thing you learn is that ambulance crews have a slightly ambivalent attitude to them. Yes they make us angry. But we also talk about them a lot in the crew room, swapping horror stories, like exasperated parents.
Almost as if we’re fond of them.
They may be bastards, as Len might say, but they’re OUR bastards.
Dave
The king of the frequent flyers in the area where I used to work was Dave.
Usually violent, abusive and drunk, Dave was a legend, the top of the charts, the big cheese. He was the Elvis of the frequent flyers. And a right royal pain in the arse.
Friday afternoon.
Called to a male, forties, chest pains.
He’s living in a filthy unkempt flat in the poorer area of town, with an enormous dog in the kitchen, who luckily appears quite friendly. We say hello. Dave’s lying on the sofa, drunk but reasonably coherent, surrounded by empty bottles and full ashtrays. The bottles are huge blue cider bottles. I look at the nearest one. It says ‘Sharing Bottle’ on it. Do me a favour.
—I’ve got chest pains. I need to go to hospital.
—Oh really.
Over the course of the next ten minutes we ascertain Dave’s chest pains (if they exist at all) are provoked by a cough and certainly not cardiac. They’re more likely to be related to the million cigarettes he smokes every day. None of his other observations point to anything cardiac. We advise him to see his doctor and leave.
Five minutes later we’re called back to the same address. Male, forties, chest pains. Back we go. Again we wire him up to the ECG but it still shows nothing – just a normal heartbeat. Again we advise a visit to the GP and leave.
I notice a packet of Diazepam on the sofa amongst all the fags and bottles.
—You know, Dave, if you keep mixing those with booze, one day you’re going to fall asleep on that sofa and just stop breathing.
Five minutes up the road the call comes pinging through.
Male, forties, not breathing.
I stare at the screen.
—I just told him that! I just told him! And if he’s not breathing how come he’s managed to phone a sodding ambulance?
—Bastard! screams Val.
Back we go.
Same old story. He’s still claiming chest pains and wants to go to hospital. It’s obvious there’s nothing the hospital could do for him. All he would do is sit there, swearing at the nurses. He’s done it a hundred times before. Once again we leave, and once again, five minutes up the road he calls again. Male, forties, short of breath. This is the fourth call.
Back we go. As before there’s nothing wrong with him that a bath and a bullet in the head wouldn’t cure. But he keeps calling, and we keep sending. While Val diverts his attention I pick up the phone he uses to call us. I take it through to the kitchen and offer it to the dog, hoping he’ll chew it up. The dog isn’t interested. I can’t really stamp on it, so I take it back through to the front room and slip it down the side of the sofa cushion so it’s not in view. Then, finally, we say goodbye and get out of there.
He doesn’t call back.
Micky
People can get that Holby City or Casualty impression of the job. But sometimes you do get a job that sounds like it’s straight off the telly.
It’s near the end of an unremarkable shift on the car and then something comes over the computer which makes me prick up my ears.
Female, thirties, on ground and covered in blood, CPR being performed. CPR? This doesn’t sound good. There’s lots of other stuff as well. Patient lying on grass outside house, caller distressed, screaming.
Jobs like this you go like fuck. Drive it like you stole it.
Which is what I proceed to do. The job’s eight miles north and I nearly kill at least one person on the way there. The Critical Care Paramedic is coming up from ten miles south and he probably nearly kills two. The patient’s down a windy road through a housing estate, and I scream down it red-lining the engine and stamp on the brakes and turn the corner to find …
… nothing. Zilch.
The square root of fuck all.
It’s a hoax. There’s a paramedic truck already there and a police car and not much else. The caller’s a local nutter who does it all the time – the police recognise the number. They’ll be going round his house in a minute to have a little word. Apparently he’s so loopy there’s not much point in trying to prosecute him, he’d probably start barking at the judge or licking the floor or crapping in the dock or something.
We all stand down as the CCP turns up, smoke coming out of his wheel arches and his ears. Not happy.
I’m just glad the call’s got me off on time. My car stinks of burnt clutch for days afterwards.
We go out to all sorts of unfortunate people, but in a way the ones I tend to feel for aren’t those that have died of a heart attack, or smashed themselves up in a car crash. I sometimes feel sorriest for people like Billy, Micky and Dave. It’s not how you die that’s important. It’s how you live.
4
Emergency Admissions
One of the problems, or tragedies, about the modern NHS is that the wartime generation, that defeated Hitler, never complained and never called an ambulance because they didn’t want to make a fuss, is dying out. To be replaced by today’s me-generation – products of the Welfare State from cradle to grave, who call an ambulance at the drop of a hat because they’ve scratched their finger opening their dole cheque. (A bit of an exaggeration but you get the picture.)
This can occasionally catch you out. There are still patients who should be much more frequent flyers …
Bob and Mildred
Evening.
We’re down in a dormitory town which is, to be frank, a bit of a dump, with more than its fair share of welfare scroungers, druggies and alkies. We get a call to a male – no age given. Has picked a spot and it’s still bleeding.
—Oh for fuck’s sake, says Val. ‘Picked a spot and it’s still bleeding’? You’re having a laugh, aren’t you?
I shake my head and we drive off to the job in the ambulance and a cloud of disgust.
I don’t spot the early warning signs. The house is in one of the town’s ‘respectable’ enclaves, neat and well cared for, and when I knock the door is answered by an elderly lady, white hair, just like your lovely grandma.
—Hello dear.
—Hello, my love. What’s the problem?
—Oh he’s in the back, through there. Thanks for coming. Sorry to get you out. He’s picked a spot and there’s a bit of blood.
—OK my love, let’s have a look at him.
I go through to the back room, still slightly peeved but determined not to show it, but that feeling doesn’t last long.
The back room is a bloodbath, claret all over the floor, sprayed up the walls in places, all over a chair. The claret’s previous owner (or container) is an elderly gent, Bob, presumably the lady’s husband, lying flat on his back, white as a sheet.
Bloody hell.
He’s still conscious, though only just, and when I even try to sit him up, let alone stand him up, he faints dead away. I lie him back down on the floor, put an oxygen mask on him, and put his feet up on a chair, to get what little blood’s left in him up to his heart and brain.
He hasn’t picked a spot. He’s nicked an artery in his leg, and because it’s an artery the blood has pissed out all over the place. There must be literally pints of it all over the floor, and he’s in shock – basically there isn’t enough blood left in his body for his heart to pump it up to his brain and keep him conscious if he sits or stands up.
It’s serious but manageable, with the right treatment. Without it, he could die. I get a dressing on the wound, though it’s not bleeding much any more, and call for backup. He needs a paramedic to put a line in so we can get fluids into him, and he needs to go off to hospital lying flat, so the leg can be fixed.
He’ll probably need a blood transfusion as well, he’s lost so much.
We get him packaged up and off to hospital, and I stay behind to try and clear up a bit of the mess on the floor, and call someone to come and be with the wife so she’s not left alone terrified. True to form, she doesn’t seem that worried anyway.
—Sorry to call you out again, darling. Would you like a cup of tea?
I tell her to sit down. I’ll make the tea.
Enid
After qualifying, the next stage in your progress in ambulance life is working on your own, in a fast-response car. You’re supposed to get to the job first and assess it and stabilise it.
You’re ‘it’.
/> And I’m doing it for the first time tonight. No Val to hold my hand. Or anyone else.
This is hard-core stuff. You make the decisions. You have nobody to fall back on, nobody to help. At least without calling up on the radio. Some people in the job decades longer than me still don’t like doing the car.
I’m shitting myself. I go over the thing with a fine-tooth comb, making sure all the equipment is there. There’s lots of it, the car’s groaning with it – looks like I’m off on holiday. Only I’m not.
Luckily, the dispatcher is a friend of mine, so I call him and tell him it’s my first night, and he promises to be gentle with me. And he is, bless him.
First job of the night is an elderly lady in a restaurant, cut leg.
Not too frightening. She’s a lovely old dear, being taken out for an evening meal by her family in the pub. And she’s hungry.
In the restaurant she’s sitting at the table, studying the menu. She’s nicked a varicose vein in her leg and the blood’s pouring out over her foot and the floor, while her family look concerned. I bandage the wound up with a pressure dressing. She needs to go to the hospital but she doesn’t want to go.
—I’ve been waiting for this for ages. I’m hungry. I’m not going to hospital.
—Please Mum, your leg’s bleeding. You need to go.
—No I don’t. I need a prawn cocktail and a main course. And pudding. What’s everyone else having?
It takes an age for them to persuade her to go.
Elliot
Midnight.
It’s been the usual horrendous Saturday night.
Mainly following the police around from job to job. Drunks fighting, so they’ve got minor facials and the police want them ‘checked out’ in the hope we’ll take them off their hands and down the hospital. Or drunks unconscious, in which case the police refuse to have them in their cells and insist we take them down the hospital. The ambulance service gets on a lot better with the police than with the fire brigade – the police are as busy as us. But sometimes the relationship’s a bit like an old married couple.
