by Wharton, Kit
She’s incontinent, with thick black, tarry faeces. This isn’t normal digested food. It’s blood. Her internal organs, liver and pancreas, are so inflamed they’re causing her agony, and her stomach lining is bleeding. Her pulse is racing and her blood pressure’s low – everything’s collapsing. Her dyed blonde hair is matted with sweat and vomit and there are clusters of spots from a rash around her mouth. Apart from that, she’s great.
We get the patient down on to the ambulance and settled and as comfortable as possible. From her I gather mum and stepdad live about 100 miles away, as does a big brother. She hasn’t completely lost touch or fallen out with them, but ‘doesn’t want them to see her like this’.
—Do they know how bad things are?
—No, not really.
She refuses to give any details, never mind addresses or phone numbers, so there’s no way to contact them anyway even if someone was allowed to. I think about this on the way in, while she sleeps awhile. What it really needs is a doctor to take over, phone her family, and for them to come and get her, take her to a clinic and commit her there, if necessary against her will, for months or even years, at enormous cost, where she can go through rehabilitation and get the nursing she’s going to need. Then it will be years of therapy, psychoanalysis, call it what you will – again at vast expense – to iron out whatever’s made her get this far. Even with all that there are no guarantees. And it’s not going to happen.
Unfortunately it’s pretty obvious what is.
When I go back into A&E later she’s gone. Fatima says she’s been sent home.
—She doesn’t have a home – she lives in a hostel.
Fatima shrugs her shoulders. She was judged fit for discharge. That’s it.
I never see her again.
I’m still thinking about her the following day when another one comes along.
The most common thing people ask about the ambulance service is how do you deal with the drunks and the alcoholics? The drunks are boring and annoying (but can be fun), but I have a lot of sympathy for the alcoholics. They’re often not the same thing for a start. Alcoholics are often long past being happily drunk. That’s probably a distant memory for them. They drink because they have to.
We’re called to a male, thirty, who’s had a fit.
The address is a bit of a dingy flat, where the patient lives with Mum. It’s a sea of fag butts and empty cans. The cans are all over the floor and table, neatly stacked like an army. A brand of well-known lager – nothing else. I still remember the adverts when I was a kid. The amber nectar – like an angel crying on your tongue, Paul Hogan used to say.
Only she seems to be vomiting green bile over your face today.
He’s dead white, shaking uncontrollably. He’s had a fit for about five minutes, been vomiting continuously for days. He’s due into a rehab clinic in a few weeks’ time and the doctors have told him not to stop drinking until then. He’s got to keep drinking the lager, his mum says almost cheerfully as she leads me to the front room. Like she’s saying he’s got to keep studying for his exams. Don’t know if she knows how ill he is.
The trouble with booze or drugs is you get addicted to them, of course. So even if you want to get off them, you can’t. Catch-22. My patient is in a Catch-33 situation. His central nervous system is dependent on alcohol, and without it he falls apart, shaking and shivering and having fits or convulsions. But the part of his body that’s got to deal with it first – the liver and stomach and pancreas and whatnot – is fucked, had enough and is saying no more. Even though he needs the drink he can’t get it, because he can’t keep it down. Catch-33.
He needs to go into hospital, so they can manage the withdrawal with drugs that stop the fitting, and deal (if they can) with the internal bleeding that’s going on somewhere in his wrecked stomach.
So it’s off to hospital we go – the same hospital the 27-year-old female was discharged from only hours ago.
I wonder what’ll happen to both of them.
I’m a pretty heavy drinker. Val’s no stranger to a few sherbets. But we’re teetotal compared to this lot.
7
Arguments
My mother was warm and funny, but often a heavy drinker and as disorganised in her own way as my father. She came from a large Catholic family from Birmingham or Bath, I never quite worked out which. She was a bit of a black sheep, leaving her family for London and a career in writing and journalism when she was barely out of her teens. She had a slightly artificially posh voice, and also a bit of a tongue on her.
Once she narrowly missed a train at the station.
—Shit.
The ticket lady stared at her.
—That’s not very nice.
My mother stared back.
—Well, it’s better than fuck isn’t it?
My parents’ speciality was the drunken, violent row. They used to regard a good row over a meal as a sort of art form, a theatrical performance, something to applaud.
Once halfway through dinner my mother picked up a fork, after some remark of my father’s, and simply stabbed him in the face, ripping a bloody great hole in his nose. Blood was pissing out all over the place. He insisted on walking out with the blood pouring down his face, rather than trying to staunch it in any way, and went home to his other family. A bit of a drama queen.
We carried on eating – there was nothing else to do. As I said, good training for the ambulance service.
Amir
Summer evening. A stabbing.
This being leafy, respectable suburbia, most times you get a stabbing, whether the perpetrator has done it to himself or someone else, it doesn’t amount to much. Most times. But not tonight.
We’re called to a male, thirties, multiple stab wounds, conscious and breathing.
Amir.
Well, that’s interesting – the multiple thing for a start. On the way to the job we’re told the assailant is his cousin – bloody hell. Attacker is still on scene, so we’re told to hold back at the end of the road and wait for the police. It turns out the end of the road is almost directly outside the house.
When the police turn up it’s just one constable who looks about ten years old and understandably nervous.
—Not going in there without backup, he says, and calls up on his radio.
So all three of us are waiting outside the house. I feel slightly absurd, but the fact the copper’s shitting himself makes me feel better. Then out comes a woman in her late sixties or early seventies, nice and sort of mumsy-looking. She’s not covered in blood or screaming or anything, and just looks at us with a resigned expression, raising her eyes to heaven. So I think sod it, let’s go in.
In the front room the patient is a tall and skinny Asian man with long black hair, lying on the floor looking stunned. He’s conscious and breathing, thank God. There are bloodstains all over his back. Another smaller man is bending over him, sobbing and saying sorry over and over again.
Then on the floor I see something which makes me think. It’s a kitchen knife with blood all over it – the sort of thing the waiter brings you in an Italian restaurant if you order steak instead of pasta. About seven inches long with maybe a four-inch serrated blade. The blade is bent at an angle of about 30 degrees. Bloody hell. I’ve eaten with a knife like that at home – I know the sort of force needed to do that. The blade has hit a bone or something – flesh wouldn’t do it. He must have meant it.
Anyway, he doesn’t mean it any more. He’s still sobbing and we practically have to drag him off the patient in order to get at him.
—They’ve always been at it, says the mum. Like cats and dogs, ever since they were kids.
I assess the patient quickly, and almost unbelievably, the damage doesn’t look too bad. He’s conscious and a good colour, the bleeding doesn’t look too catastrophic from the outside, his lungs are clear and he can breathe well. Not for want of injuries. There are six or seven puncture wounds all around the back and abdomen, at least one over hi
s lungs, and another where his heart would be. But his blood pressure’s holding up and he’s doing well. We get him on oxygen and into the ambulance as quickly as possible, while the policeman arrests the cousin, who is sitting on the sofa still sobbing how sorry he is. By this time the mum just looks bored.
We put in a call to the hospital and rush him in there – the danger is internal bleeding, and you won’t know much about it until the patient’s blood pressure collapses and he dies. He’s fine all the way in, and I think he was lucky and made a full recovery, though we didn’t find out. (We often don’t.)
Nowadays Jo and I spend half our time at home listening to the kids shouting at each other and telling them to keep it down. This is a bit different. (They get on pretty well most of the rest of the time.)
Another time, at my parents’ table, more training.
My mother’s turn for treatment. She had cooked a huge risotto, which was on the table in a big saucepan. My mother said something which infuriated my father, so he got up, seized the handle of the pan, picked it up and smashed it over my mother’s head. The risotto went flying out of the pan and splashed up against the wall.
My mother looked stunned. Now, of course, I would check her for concussion, injury, signs of raised intercranial pressure. But I wasn’t that fussed at the time. (I was only about seven.) I didn’t like risotto. I went down and got Kentucky Fried Chicken. No harm done.
Once my father came over, just back from abroad.
He’d brought my mother an enormous plate, beautifully patterned. The inevitable row began as he was leaving. My mother picked up the plate in front of him, and dropped it on the floor.
Smash.
Like miniature All Blacks, we had to hurl ourselves at him. We thought he was going to kill her.
Dave and Brian
Another 999 call. Mid-afternoon.
We’re called to a dispute between two neighbours, which you wouldn’t have thought was too much to worry about, but one of them’s decided to settle it with a baseball bat.
When we get to the job, it’s a nice detached house (though perhaps not detached enough) and the patient’s sitting in his conservatory with blood pouring out of a couple of holes in his head, but he’s still conscious and breathing, and not screaming in pain.
He and the neighbour have had some sort of argument over a borrowed lawnmower or something, and the neighbour’s come round with the bat and seen if he’ll take that in exchange.
And he’s been pretty persuasive.
Our patient has at least two impact points on the skull from which the blood’s coming, and at least four or five over his back when he fell to the ground and the neighbour kept hitting him. You can see the bruising. None of the wounds on his back are on the spine, so we don’t have to immobilise him. Also, as much as we can judge, the skull around the head wounds seems to be intact (it takes a hell of a lot to break a skull). Even so, we’re in a hurry to get him into hospital so the doctors can look at him.
Then the police turn up, not surprisingly. Just one girl on her own, small, blonde and pretty, who comes up to my chest.
We’re sorting out the patient and she’s taking down his particulars or whatever they call it when the wife looks over my shoulder.
—Oh my God!
—What?
—It’s him! He’s come back!
We look round and there he is, walking down the driveway towards us. Quite a big bloke.
Now I couldn’t fight my way out of a wet paper bag, but I’m six foot two and I can see the poor police girl’s going to struggle if he’s serious. She’s walking towards him undoing her handcuffs and thinking God knows what, so I fall in beside her.
Luckily, no such thoughts are in his mind. He’s obviously gone home and thought about things and now he’s walking towards us with his hands held out for the cuffs.
He comes quietly, as they say.
And we take off for the hospital with our patient, who’s showing slightly worrying signs of getting sleepy, so we call it in so they’re expecting us.
I didn’t find out any more about the job, but I imagine relations in that street were pretty frosty for a while.
The past is a foreign country, they do things differently there …
At one point my father and stepfather met up in a cafe, two men together, having a summit meeting on what to ‘do’ about my mother, as if she was an outbreak of Ebola or a mad African dictator. My father asked my stepfather – still living with my mother – if he still loved her. If the answer was yes, he would break the affair off. The answer was no.
8
Children
The ambulance service often gives you a pretty jaundiced view of the human race. Especially when children are involved. That’s when you get angry. At the parents, or fate, or whatever or whoever is in charge of this mess.
Louise
Called to a girl, bitten by a dog.
It’s a grim, cold winter’s evening and the address is on the outskirts of town, a small worker’s cottage with the garden overflowing with toys and junk – not a good sign. Inside is mayhem. The house is dirty and untidy, but we’re not too concerned with that because in the kitchen is Louise, with a bloody great hole in her face. The dog’s somehow managed to bite her on the flesh of the cheek and ripped a three-inch hole right through the full thickness of the flesh to the jaw behind. Horrendous. She’s in her aunt’s arms and both are absolutely hysterical and covered in blood.
For some reason the police have been and gone. They’ve taken the dog with them. Some sort of bull terrier no doubt. Probably crossed with a tank or armoured personnel carrier. I don’t know what they do with dogs in this situation but I imagine it’s pretty terminal. Meanwhile we’re trying to deal with the poor little patient.
We try to get a dressing onto her face to cover up the worst of it, and to give her some paracetamol, but it’s fairly hopeless on both counts. She’s screaming.
This is one of those jobs where there’s little you can do apart from get them on board, make them as comfortable as possible, and go for the hospital, where they’ll sedate the girl and get to work on her face. It’s called ‘load and go’ in the ambulance service.
Load and go like fuck.
Just before we take little one and aunt in I go and tell uncle what we’re doing. He’s a big, unshaven bloke who doesn’t look too bright.
—I don’t understand it. The dog’s usually good as gold. But she’s been winding it up all day. Mucking around.
—Winding it up?
—Yeah, pulling its tail and stuff. Winding it up. So we just left them in the front room together to get on with it.
Like I said, he doesn’t look too bright. They just ‘left them in the front room together to get on with it’. Which I suppose they have. Not exactly Barbara Woodhouse.
You really wonder with some people. You really fucking wonder.
At the station I tell Len all about it. He isn’t impressed.
—Stupid buggers.
One night my parents went out to a party and left us to fend for ourselves. I was about ten. They were supposed to be back late, but didn’t come back at all. Not until nine the following morning. They returned looking sheepish, with a pineapple as a peace offering. I still remember telling them a pineapple wouldn’t have done much good if they’d been run over by a truck.
They nodded. All the loony parent stuff, the fighting and the drunkenness, was bound to have an effect. I ended up with psoriasis, anxiety and obsessive–compulsive disorder, unable to leave the house without checking the oven and taps are off a thousand times, that sort of thing. It’s about feeling in control – and I suppose the service is all about being in control when everything’s gone pear-shaped. I used to wait up in the evenings for my mum to get home, even if it was midnight or beyond, because I couldn’t sleep knowing she was still out, frightened she’d come back and burn the house down drunk.
I’m all right now. Sort of.
Lucy and Jessi
ca
Afternoon. We’re called to a female, forties, unwell.
The address is a top-floor flat in a tower block in our area, and the patient’s daughter’s called us. She and her mother live together alone, she is only fourteen, and she pretty much looks after her mother, not the other way around.
The reason she looks after her mother is her mother is very, very fat. She weighs somewhere between 20 and 30 stone. She has a raft of medical conditions, some causing her weight gain, others caused by it. She sleeps in the front room because that’s the only room big enough to accommodate her bed and commode, and it’s almost impossible for her to walk anywhere. It’s almost impossible for her to stand. She’s enormous, sweaty, smelly – she’s a human being, but for her daughter, she must be a nightmare.
Today she has an infection, one of many, and her daughter’s called us because she can’t be managed at home.
Getting her out proves almost impossible. We call another crew to help lift her across from her bed on to our carry chair, which can only just take the weight. We manage it, which is good, because otherwise it would be a job for the fire service.
I can’t help thinking the real victim in all this, the person who’s really suffering through no fault of her own, is the patient’s daughter. She’s a teenager – she should be going out and having fun, bringing friends back for tea and sleepovers, having boyfriends, being looked after herself. Instead she’s a full-time carer for her own mother when she’s not at school. I can’t imagine she can bear to have friends back to witness what her mother’s become, and you can just feel the horrific embarrassment she’s feeling with us in the house. We treat her and her mum with as much gentleness and respect as we possibly can, for her sake, as much as her mum’s.
But you feel your heart breaking when you look at her pale, shattered face.
Only about a mile away is another woman we go out to regularly. Again she’s very large – at least 25 stone. She very rarely gets out of her oversize chair, even to go to the loo, but is hoisted by carers from the chair to her bed, then from her bed back to the chair. Her life is watching the telly. Jessica lives with her son, who is maybe in his twenties, and is also her carer.
