the ghost of bert

Godfrey’s son, Ian lets me in.
‘He’s in the front room watching athletics,’ he says. ‘Go on through. I’m just making some tea. D’you want some?’
‘No – I’m good, thanks.’
‘Okay, then.’

An easy start to things – which is why it catches me off guard to find Godfrey in an armchair, his head thrown back, his eyes closed, his mouth slack, his arms by his side and his legs straight out, twitching and jerking.

If there was one thing I learned from all my years as an EMT in the ambulance service, it’s not to panic. There’s always time – even if it’s just a few seconds – to take a moment and see as clearly as possible what’s happening in front of you.

I’ve seen a great many seizures, and of course they vary enormously in presentation, from absences and automatisms to full-body convulsions. Godfrey’s was different to any of those, though. It struck me as the kind of performance you’d give if you’d only seen these things on the telly. He seemed to think it was mostly about waggling his hands at the wrist.
‘Godfrey? Hello! It’s Jim, from the hospital,’ I say, putting my hand on his shoulder.
He immediately stops, straightens up in the chair, wipes his mouth with the back of his hand and shakes his head.
‘Dear oh dear,’ he says. ‘Some kind of nurse you are.’
‘Nursing assistant.’
‘I thought I’d give you a bit of a scare when you come in. But you’re obviously a hard-hearted bastard.’
‘Well at least that’s some kind of heart, anyway.’
‘I can see we’re going to get along.’
‘I hope so. I can always get the big needle out…’
‘Now, now.’
Ian comes in with the tea.
‘You’re not making a nuisance of yourself, are you, Dad?’ he says, handing him a cup. ‘I can only apologise on behalf of my father. I’d say he means well, but I’d be lying.’
‘I’m not getting involved,’ I say, setting out my stuff.
‘Too late. You’re involved,’ says Godfrey, taking a sip of his tea. ‘Ahh! Now then. I suppose you’ve come about this leg?’

Godfrey strikes me as depressed, which isn’t surprising, given the trouble he’s had with his leg. Although he’s elderly now, he’s been pretty independent, living alone, taking care of himself and so on. Now his mobility is seriously compromised, he’s found himself thrown onto the care of his family, which mostly means Ian, being the closest geographically, and carers coming in to help with this and that. It’s obviously as much a torture to him as the pain itself, and it looks like he’s supplementing his Gabapentin and Co-codamol with a little clowning.

‘You wouldn’t think to look at this wreck of a body, but I used to be a diver,’ he says. ‘That’s a hard job. You’ve got to be mentally tough. Not many can hack it, you know, down there in the dark and the cold.’
‘I bet.’
‘I’ve done some things in my time. I remember once we were sent in to find a body. It’d been there so long, the arm came off in my hand.’
He demonstrates, widening his eyes and pulling away from a phantom corpse.
‘I enjoyed the work, though,’ he says, relaxing back again. ‘Kept me busy.’
Ian nods at me from across the room. I can tell he’s heard these stories a million times before.

Godfrey’s quite a handful but I’m warming to him. He reminds me of my Uncle Bert, who had the same mischievous sparkle in his eyes, deliberately saying something provocative and then waiting to see what you’d do. I invoke the ghost of Bert to help me whilst I’m talking to Godfrey, joining in the banter, until it really feels we’re building a good rapport.
‘You’re all right, son,’ he says. ‘I’ve forgiven you for leaving me to die earlier.’
‘I could tell you were all right because you still had your hand on your wallet…’

The phone rings. Ian goes to answer it in the next room. I start filling in the obs sheet. Godfrey turns his attention to the race on the TV.
‘Look at him, running with his arm in a sling,’ he says. ‘That’s good, innit?’
‘It must make it so much harder.’
‘And look at that one,’ he says. ‘Horribly burned.’
It’s a moment before I realise he means the black athlete.
Godfrey grins when he sees the comment has landed. He folds his arms, and watches me.

It throws me far more than the fake seizure at the beginning of the session, and for a moment I can’t think what to say. It’s disturbing and disappointing enough, but what makes it worse is the intention behind it. This is obviously a test, to see if I’m really on his side, part of the crew, one of the gang.
I return his gaze a moment whilst I think.
He’s a depressed, embittered old man in a great deal of pain. I’m not going to pretend that I think it’s okay, but I don’t think it’s going to achieve much if I confront him. In the end I settle for a miserable compromise.
‘You can’t say that,’ I tell him.
‘Oh! Here we go! The thought police. In my own home, too. What’s the world coming to?’
‘It’s just – not a nice thing to say, Godfrey. People are people. You should know that by now.’
‘You and me are gonna fall out, mate.’
‘I don’t care, if you say things like that.’
Ian comes back in the room.
‘What’s happened?’ he says.
‘I said a bad thing,’ says Godfrey. ‘Apparently.’
Ian winces and shakes his head.
‘Once again – I can only apologise for my father.’
‘That’s okay,’ I say, automatically. ‘Don’t worry about it.’
But the way Ian takes his seat again, quietly, with an exhausted hang of the shoulders, I can tell he does.

not exactly Lear

Zikri and I have been asked to do an environmental assessment on a patient.

‘What is this environmental assessment? What do they mean environmental assessment?’ says Zikri, saying it so emphatically again and again it sounds like a sneezing fit. He rapidly flips the page backwards and forwards like he’s trying to shake the sense out of it by main force. ‘They’ve already said it’s unhygienic and dreadful. Faeces on the floor etcetera, a terrible mess. What more do they think I can add to that? Hmm? A colour chart?’
I love working with Zikri. He’s a zesty combination of warmly humane and emphatically pragmatic. With his slightly greying goatee and his steel framed glasses, and his habit of staring at you with his mouth slightly open, like he’s savouring everything you have to say, and preparing himself to jump in with warm words of praise or a stinging rebuke. He’s the best teacher you never had. He’d have made a great theatre director, or maybe an oncologist. You could take any amount of criticism from Zikri and still think he’d given you a compliment.
‘He asked Anna to leave. So she did. She wasn’t able to complete the assessment, but she was there long enough to get this much done. Nowhere does it say she thinks he lacks capacity. And now we’ve been asked to go in and do an environmental assessment. I think all we’ll be doing is making him angrier and less inclined to co-operate than he already is.’
Zikri takes his glasses off and pinches the top of his nose.
‘Well, okay, alright,’ he says at last. ‘What time do you want to meet there…?’

*

I’ve been to a great many scenes of self-neglect, both in the ambulance and latterly as a community health worker. But I have to say Mr Frederickson’s basement flat is by far and away not anything like any of those places. In fact, I’d go as far as saying it’s actually very nice. It has a warm, stripped pine floor; walls populated with framed playbills, woodcuts of seabirds, watercolour landscapes, family photographs; quirky, vintage furniture; palms in jardinieres, and a view through a bright sash window of a rich and well-tended courtyard garden. I can’t help thinking we’ve come to the wrong house. In fact I’m so certain that must be the case, I quickly check the paperwork as Zikri makes the introductions.

‘It’s lovely to see you both,’ says Mr Frederickson, shaking our hands and then tying his dressing gown more tightly around his waist. ‘You catch me rather déshabillé, but then I suppose it is the weekend, so perhaps you’ll let me off.’

He’s utterly charming.

Zikri looks at me.

I know exactly what he’s thinking.

Environmental assessment.

‘If you’d be so kind to pass my apologies to your colleague,’ says Mr Frederickson, ‘… the girl who came here the other day. I’m afraid she caught me at rather a bad time. I stood there with my hair all over the place. I must have looked like Lear on the heath. I think I scared the poor girl out of her wits.’
‘No worries,’ says Zikri. ‘We will be sure to convey your apologies’
‘That’s kind of you,’ says Mr Frederickson. ‘Now – how can I help you this morning?’
‘Well…’ says Zikri.

stars in battledress

‘I’ve never been what you might call quiet,’ says Elsa, tugging the bedclothes up around her neck. ‘That’s one thing you could never accuse me of. I suppose you’re either a talker or you’re not. You never have to worry about awkward silences with me. It’s just the way I’m built. Like being left-handed. Or having a head for heights…’

I’m waiting with Elsa for the ambulance to come. I’d been sent round for an initial assessment, ECG and bloods. But it was clear as soon as I walked in the bedroom that Elsa was acutely unwell. A closer examination led me to suspect she was suffering a serious internal bleed, so I called 999.

‘They’ll be here soon,’ I told her, putting the phone down. ‘Try not to worry. Meanwhile, I’ll get a few things together…’

*

It’s been a while, now. Three-quarters of an hour.

When I go next door to phone ambulance control for an update, I’m told that they’re doing their best, an ambulance will be dispatched just as soon as one is available – only, people are having heart attacks, strokes…. surely I can understand? I know it’s difficult, I tell him, but the fact remains, we need to get Elsa to hospital as soon as possible. She’s compensating reasonably well at the moment, but I don’t think that’ll last much longer. We’re doing our best, they say. Of course, I say. I appreciate your help.

When I hang up I carefully document the delay.

‘Not long now,’ I tell Elsa, going back into the bedroom.

Before what, I wonder. She looks so fragile, lying on the bed like this, the sockets of her eyes ghosting through the pallid stretch of her face.

‘I’m glad you’re here,’ she says. ‘I wouldn’t want to do this on my own.’

‘I’m glad I’m here, too,’ I tell her, sitting beside her to do another set of obs. ‘So – go on. You were telling me about Stars in Battledress…’

She’d always been mad on the stage, she says. Singing, dancing, doing sketches. And that was what they wanted. A friend of hers put her up to it. She said I was just the kind of girl they were looking for. It was such a shame what happened to her.

‘Why? What happened?’

‘It was a famous murder case. She was on a cruise ship coming back from a show in South Africa and she was murdered by one of the ship stewards. He tried to make out she’d agreed to have sex with him, but then died of a fit or something, and he panicked and shoved her body out of the porthole. They never did find her body. He was convicted, of course. I think he only escaped hanging because of some loophole or other. Died in prison, years later. Funny how these things work out. Poor Gay. She was such a kind girl, a lovely girl. But these things happen, I suppose. On a ship or anywhere else. You’ve just got to be careful and lucky and hope for the best.’

Elsa tells me about the shows she was in. About one in particular.

‘As well as performing, everyone had a job to do. Mine was to put together these wooden steps for the big dance number in the second half. I was just tightening up the screws when someone dropped a curtain pole straight on my head. Knocked me clean out! When I came to there was only a minute to go before I was on. I had no idea who I was or where I was, but the lights came up, they pointed me in the right direction, and I walked out into the light. Anyway, the words seemed to come from somewhere, so it worked out in the end.’

‘When that show was over I moved into the intelligence corps. I remember – we were all lined up in the corridor, six girls in front, about thirty men behind. You can imagine what that was like. I was the last girl to be called forward. When I heard my name I thought – right! I’ll show these men a thing or two! – so I marched as smartly as I could up to the desk, swinging my arms and hips. But you see, what I didn’t realise was there was this rug just in front of the desk, and the floor was highly polished. As soon as my feet touched the rug it flew out from under me and I slid the rest of the way on my aris, disappearing up to my shoulders in the footwell. The Major he stood up and peered over the edge of the desk.

‘Are you alright down there?’ he said.

‘Yes Sir!’ I said, and saluted, flat on my back, and everyone laughed. But it didn’t do me any harm, apart from a few bruises. They took me on.’

The flat door buzzes. I’m relieved to hear it’s the ambulance.

Two paramedics walk in.

‘Alright?’ says one I vaguely recognise. ‘Wait a minute… didn’t you use to work for us?’

naturally three

Gemma, the OT, is pregnant. So pregnant, in fact, she gets asked dozens of time a day how much longer she plans on coming in, as if the questioner thinks she’s slightly crazy, and they’re worried they’re going to find her conducting a patient assessment with a baby bumping along behind her, still attached to the cord.

‘Because you really are so big and out front,’ says Faith, stirring her hot chocolate slowly, before licking the spoon and then using it to trace in the air the generous arc of Gemma’s belly. ‘I imagine this means you will be having another boy.’

‘I don’t think so,’ says Gemma, leaning back against the sink. ‘The scan was pretty clearly a girl. But I’d be happy either way.’

‘Ah – you see! But these scans and things, they can be wrong. I had a friend back in Zimbabwe, she was forty-two years of age, and she had one more baby, and she decided enough was enough. So when the baby came she called him Finish, and she went straightaway and had her tubes tied. But then, you see, the next year, because of recanalization or something else I don’t know what – the very next year, she fell pregnant again. And she gave birth to a healthy baby girl. And do you know what they called this baby girl?’

‘Miracle?’

‘No. That would have been a good name. But no! They called this baby girl Stop!’

‘What were her middle names? Please Dear and God?’

‘I don’t know that she had any middle names. No – it was just Stop, I think. So then she went back to the surgeon, and he said okay, okay, and he tied the tubes a little tighter this time, and that was that. Six children, and hardly room to put four.’

‘I’ll be happy with three. I think three’s plenty.’

‘Yes. Three is a good number.’

Faith picks up her hot chocolate and takes a sip, then cradles it ruminatively beneath her chin.

‘But you know something, Gemma – I can’t think of anything in nature with three of anything. Can you? Four legs on an elephant. Four legs on a cat. Two on a kangaroo. But three…?’

‘I think an octopus has three hearts,’ I say, squeezing in between them to rinse my cup at the sink.

‘Ah! Well! There you go, then,’ says Faith. ‘You wouldn’t want to be like an octopus, would you? Although, maybe that wouldn’t be such a bad idea. That’s one thing you definitely need more of with babies.’

‘What – hearts?’

‘No. Arms.’

technical glitch

The rush hour has a hectic, drawn-down feel, people hurrying home through the damp streets, clutching their collars against the rain, struggling with umbrellas, the headlights and brake lights of the traffic around them fitfully illuminating the wintry October night.

Arthur is our last assessment for the day. If we’re to be off on time we’ll need to be quick, but so far at least, the omens aren’t good.

To begin with, we just cannot find the damned house.

I’d spoken to his wife June just half an hour ago to let her know we were coming. But now when I try to call her to ask where on earth thirty-eight South Road is, the phone is permanently engaged. We park up outside the block which, on the Satnav at least, bears the flag. There’s a man sheltering in the doorway, smoking a fag. When I ask him for directions he shrugs and taps some ash off to the side, carefully holding the fag cupped in his hand to shield it from the rain.
‘Is that a flat somewhere, maybe?’  he says, shuffling from side to side, glancing beyond me down the street. ‘Dunno, mate,’ he says. ‘Can’t think.’
We go round him, into the offices of what turns out to be a parcel delivery company. The receptionist behind the desk is bright and helpful, determined to find out where number thirty-eight South Road might be.
‘Sorry to bother you..’ I tell her.
‘Not at all,’ she says. ‘Happy to help. One…. moment….’
She taps around on the computer.
‘Oh! Apparently this is thirty-eight!’ she says, setting back and blushing. ‘Sorry – I only started here yesterday.’
‘So – do they live upstairs, then?’
‘No. Maybe. I’m not sure. I thought that was just a storage area.’
The manager comes through – slowly, as if he’d been hiding round the side of a screen and was reluctant to reveal he’d heard the whole thing. He stares at us neutrally as the receptionist explains who we are and what we’ve come for. No, he says. This is sixty-eight. And no, there isn’t an elderly couple living upstairs amongst the boxes, not as far as he’s aware.
‘I’m sure I would’ve seen something,’ he says. ‘Some nibbled cardboard, maybe a hat. But anyway – let’s have another look on the computer.
We huddle round another laptop as he opens Google maps. It seems a bit weird, going into street view for what is effectively the area just beyond the window, but it’s nice of him to try, and so long as June isn’t answering, I can’t think what else to do.
‘Here we are…’ he says.
He zooms in, but unfortunately, a huge truck had been passing the day the Google mapping car drove down South Road, so we’re unable to get any further with that.
‘Not to worry,’ I tell him. ‘Thanks for your help.’
I’m aware of them standing side-by-side at the counter, following us with their gaze as we hurry out into the rain.

Back in the car I try calling June again. This time she answers.
‘Oh,’ she says. ‘Everyone has this problem. I bet you followed your satnav, didn’t you? What the machines don’t seem to realise is that South Road actually starts beyond the traffic lights.’
‘Does it?’
‘Yes! We’re tucked away up here, but that’s how we like it.’
We leave the car parked where it is, because to move it would mean driving all the way round the one way system, which at this time of day would take forever. By the time we reach the front door, we’re both soaked through.
‘Oh dear!’ says June. ‘Is it raining?’
She shows us in to the narrow hallway, where we take off our coats and shoes and go through to a modest sitting room. The house has electric lighting, the sockets and switches so old the electricians who screwed them into place were probably tutting about the Suez crisis.
June is content, though. She sits by the fireplace, as immaculately pearled, coiffed and cardiganed as a minor royal.
‘He’s upstairs in bed,’ she says. ‘Although I don’t suppose he’ll be terribly pleased to see you. What exactly is it that you want to do with him?’
‘We’ve been asked to come in by the care agency to do a bed assessment,’ says Beatrice, the OT leading the assessment. ‘The carers say that the one Arthur’s in is too low, especially with his reduced mobility.’
‘He can hardly stand,’ sniffs June. ‘He’s pretty frail, you know.’
‘Exactly. We want what’s best for Arthur, but at the same time we have to be mindful of the health of the people looking after him.’
‘I know that,’ says June. ‘I know that very well. I’ve got arthritis as it is. It’s not doing me any good, bending down all the time.’
‘Absolutely.’
‘It’s just he’s such a stubborn old so-and-so. I can’t see him agreeing to a hospital bed.’
‘I think we have to try, though, June. Otherwise we’ll just run into more problems further down the line.’
‘Well. If we do, we do.’
‘Shall we go up and introduce ourselves?’
‘I’ll show you the way,’ says June, getting up with some difficulty. ‘Just don’t expect me to run there.’
The staircase rises steeply, past the first floor landing, winding on and up into the gloom of the upper storeys. I’m glad Arthur’s bedroom is on the first floor though, as getting this far has taken a fair while, June struggling to make the climb, putting her good left foot up first, then hobbling up with the right, sliding her hand along the rail, pausing for breath, and then repeating the process again. The nearer we get to the landing, the more distinct is the noise of Arthur’s oxygen machine, whirring and clicking beneath a large, foxed print of Napoleon’s retreat from Moscow.
‘He’s through there,’ puffs June. ‘You go on.’
The notes had described Arthur as a palliative COPD patient, not quite end of life. The ‘not quite’ is a surprisingly optimistic qualifier, certainly from where I’m standing. The ravages of his respiratory illness combined with his extreme old age have left him cruelly stripped of anything resembling flesh. His hands lie outside the covers, and it’s astonishing to see their complex mechanism laid as bare as an anatomical model: the tendons, the ligaments, the veins.
It’s a shock to see him open his eyes.
‘Oh,’ he says. ‘And what do you want at this ungodly hour?’
‘It’s half past six, Arthur’ says June, finally making it into the bedroom and sitting down on a rattan chair that creaks dangerously.
‘Yes. I know. Half past six in the morning.’
‘In the evening’
‘The evening? Have I really been sleeping all day?’
‘Yes, Arthur. You have’
‘Well, I humbly beg your forgiveness, one and all,’ he says. ‘I find my rather straightened
circumstances are not conducive to keeping a proper track of the time.’
‘No worries!’ says Beatrice.
‘I have this marvellous electronic watch, d’you see?,’ says Arthur, slowly lifting up his left arm.  An old Casio digital watch slips down almost to the elbow.
‘Unfortunately it seems to have stopped working,’ he says, gathering it back up to his wrist, and then relaxing his hands back on to the covers. ‘Once upon a time it used to beep’
The business with the watch seems to have exhausted him. His breath comes in and out through his slack mouth, making a dull whistling noise.
The carers were right to be concerned. Arthur is more or less bed-bound, on a low single divan in the corner of the room. I can’t imagine how you would go about washing and cleaning him, creaming his pressure areas, changing his pyjamas. Even sitting him up to drink would be a struggle. When we’ve roused him again, Beatrice explains the situation with great courtesy and clarity, gently steering him in the direction of a hospital bed.
‘They’re very comfortable,’ she says. ‘You can change the position at the touch of a button, sit up to eat or watch telly, raise the mattress at the knee to ease the pressure on your legs, go up and down – whatever! They’re brilliant, really. And then your carers won’t have to worry about hurting their backs. Because if they do, Arthur, they won’t be able to come in and help you, or any of the other patients on their books. And I know you wouldn’t want that, would you, Arthur? Hmm?’
He slowly shakes his head from side to side, the oxygen tube riding up over his ears and back down again. Someone’s put a little scrap of tape on top of his left ear, to stop it rubbing.
‘No,’ he says. ‘I completely understand what you’re saying, and I thank you for coming here and saying it. But I’d really rather not be moved. I’d rather just be left here in peace for now, and everything else can wait. Thank you.’
We try a little while longer to persuade him to change his mind. In the end, though, the best we can manage is to arrange to come back the following day.‘It’s been lovely meeting you,’ says Beatrice, taking his hand in hers and giving it a squeeze.
‘Likewise,’ he says. ‘Only – when you come back – please, don’t make it quite so early in the morning.’

doggerel & catterel

sitting on the sofa, laptop on lap
wondering what to write a poem about
whilst over in her basket by the cupboard
her head resting on a cushion
that actually has a picture of her head on it
a lurcher version of the Turin shroud
Lola is giving me a look
so professionally woebegone
it would make a robot sob
so of course, what else could I do?
I think about moving my legs
Lola is up and on the sofa
before my feet are on the floor
turning round a couple of times
then slumping into place
running through such a repertoire of chop smacking,
backward glances and eyebrow raising,
it’s perfectly clear
how disappointed she is in my behaviour
but – of course – blessed as she is
with a limitless capacity to forgive
she somehow finds the strength to move on
and starts scratching her ear
with an elegant back leg
quickly building up speed and intensity
until it’s a terrifying whirling blur
like the release of an over-wound toy
and just when I think I should intervene
because she’s in danger of ripping her ear off
and sending it flying across the room
it strikes me (I mean a thought does,
not the ear, thankfully):
isn’t this a bit like me?
metaphorically scratching my head,
wondering what to write a poem about
and then – something else:
maybe I could write a poem about how writing a poem
is a bit like a dog scratching her head
but of course, she’s stopped now
and her ears have flicked up
she’s heard something interesting
that demands her complete attention
something coming in through the cat flap
It’s Solly, Lola
You know?
Solly – the other animal that lives here?
The cat?

little red rookie

It’s too much of a coincidence. I’d put money on that ambulance car parked outside the block being for Adnan. When I buzz the intercom, the voice that eventually answers – not the patient’s – sounds very familiar to me.
‘Well, well! I thought I recognised the appalling handwriting!’ says Ryan, throwing the door wide and grabbing me to him in a great big uniformed bear hug. ‘How’re you doing, man?’
‘I’m good! I’m good!’
‘Yeah – you are!’

It’s been a while since I’ve seen him. Two years, in fact, ever since I left the ambulance service and made the sideways step into community health. I’d run into most of the other crews in that time; Ryan is probably the last.
‘I’d heard rumours,’ he says, showing me into the flat. ‘Tracks in the snow, that kind of thing. I have to say you’re looking well. Horribly well. It’s quite disgusting how well you look.’
‘No nights’ I tell him. ‘That and not having a radio on my belt.’
‘Damned right,’ he says, slapping me on the shoulders again. ‘Completely damned right. Well, well!’
He ambles back over to the sofa, sits down with a great, easeful sigh, as impressively as a tattooed Viking warrior asked to wait out the battle in a chintzy front-room.
‘What’s your involvement, then, Jimmy boy?’
I can tell from his demeanour he’s not worried about the patient. And it’s true – Adnan seems comfortable enough, in the same high-backed chair I’d left him in just that morning, his leg up on a riser.
‘Tinzaparin injections,’ I tell him. ‘A daily prophylactic dose, post knee op. And then just obs and generally making sure everything’s okay.’
I smile at Adnan; he nods and waves his hand in the air.
‘We used to work together,’ I tell him, by way of explanation, but I can see he doesn’t understand.
‘Where’s Rema?’ I say, turning back to Ryan.
‘The daughter? She just nipped out to her car to get her phone.’
‘So – what’s brought you over, then?’
‘It came through as a difficulty in breathing, but everything checked out and it looks more like anxiety exacerbated by abdo pain – which I’m guessing has something to do with Adnan not opening his bowels these past five days or so.’
‘Yep. That’s definitely a thing. The enema should be delivered early this evening.’
‘Great. Okay. So when Rema gets back, why don’t we all have a bit of a review and decide where to go from here?’
‘Sounds good to me. Meanwhile, I’ll do the Tinz.’
‘Excellent.’
And he carries on writing, stopping every now and again to chat and swap juicy bits of gossip.

It’s great to see Ryan again. I learned so much about ambulance work from him – how to take each job as it came; how to recognise when you had time to step back and think, and when you didn’t; how important it was to keep your sense of humanity, and humour, and how to conserve your energy for the long and relentless run of it all.
It was always such a comfort turning up on station for a shift to find out I was working with him. It would fill me with a great sense of security. I knew that whatever happened that day or night (and for some reason, particularly night) so long as I was with Ryan, I’d be okay, and everything would be fine.
I have one particular memory. It was early on in my time as an EMT, and I was still in that phase when every job that came through filled me with horror. We’d been called to an unconscious patient in a pizza restaurant. When we got there the place was in uproar. A gang of drunk teenage boys had gone in for something to eat, and one of them had passed out on the floor. Whilst I tried to figure out whether he was actually unconscious or not (he wasn’t) the others were jumping around, tipping oregano on his head, laughing, swearing, play-fighting and generally getting in the way. I’d tried to be as commanding as I could, but nothing worked. (I can’t remember where the restaurant staff were, and the police certainly hadn’t pitched up yet). Ryan had hung back for a moment, just to see what I could do for myself. When it was clear I’d lost control, he waded in.
‘Right. You, you and you – OUT!’ he’d thundered. And although I admit my memory of the whole thing is probably unreliable, still I think I see him striding out of the restaurant, kids hanging off his arms and neck like rangy dogs round the arms and neck of a gigantic bear, before being hurled off into the night with yelps and barks.

If there was ever a paramedic who deserved his own graphic novel, it was Ryan. I would certainly have bought a copy (and got him to sign it, too).

Rema hurries back into the flat, and smiles when she sees me.
‘Oh – hi! How are you?’ she says, finishing the call she was making.
‘I’m glad you’re back,’ says Ryan. ‘Jimmy was doing his best, but the only Arabic word he knows is habibi.’
And they all laugh so much – even Adnan – I can’t help blushing.

pushed for time

I have an appointment at three o’clock, a double-up with an occupational therapist at the house of a patient discharged from hospital that day. But so long as everything falls into line, and the traffic is only slightly north of reasonable, and I manage to pare each visit down to the barest and most pragmatic interaction permissible by law, three o’clock is perfectly achievable.

Of course, it doesn’t work out that way.

The ECG machine decides to play up, in that almost supernatural way electrical equipment has sometimes of sensing your impatience and transforming it into pure cussedness. And when I try to draw blood from the second patient, I have as much luck as if I’d staggered out into the garden and jabbed the old apple tree. That, plus running into a horrible thickening of the traffic heading west, so inexplicably and uncharacteristically bad it makes me think I’’ve missed an emergency radio broadcast telling everyone to drop everything and clear the hell out of town – all this means that by the time I’m pulling up outside the house, half an hour late.

‘I -am-so-sorry!’ I say, piling in through the door with all my bags.
‘That’s okay!’ says Rick, the OT. ‘We’ve just been taking our time, going through a few things. It’s alright.’
Gil, the patient, is sitting forward on the edge of a sofa. His hair is dyed crow-black, back-combed in Gothic style, which only seems to accentuate the extreme pallor of his face, and the dark hollows of his eyes. Shaking his hand is like scooping a fragile bird into my fingers.
‘Pleased to meet you.’
‘Likewise’
I sit down on a low stool as Rick brings me up to speed. He gives me the discharge summary to look over, too, and I glance at it from time to time. I’ve already been told the basics – the alcoholism, self-neglect, the concerned neighbours, the intervention of the social work team and so on – and the fact that a deep-clean company had been brought in whilst Gil was in hospital. What I hadn’t been told though was the seriousness of his situation now. The discharge summary lays it all out in dry and technical language; beyond it, like seeing a dark and formidable landscape through a formal window, is the hard truth of the thing. Gil has come home to die.
‘If you want to get your bits and pieces out of the way whilst I finish this bit of paperwork…?’ says Rick, as I hand the summary back.
‘Sure! Why not?’ I say, grabbing my kit and going over to kneel by Gil. ‘Is that okay?’
He accedes to it all with a measured kind of passivity, smiling often, but in a gentle way, like someone who’s decided the only thing he can change about the destination is his understanding of the journey.
I don’t push anything. Just the basics. And when I’m done I shake his hand again, gather my things together and leave Rick to finish off.

Back outside, I’m throwing my bags in the boot of the car when an elderly man in a flat white cap, anorak and check shirt stops right by me. He holds a map book almost to the end of his nose, looks up and down the street, lifts his tinted glasses, presses the map book closer, squints, looks up and down the street again, and then takes his cap off and scratches his head. It’s all pretty emphatic,  like watching a modern clown doing a skit called Lost.
‘Are you alright there?’ I say.
‘Me? No. I’m late and I can’t be.’
‘Where’ve you got to get to?’
He brings the map over, hands it to me, then takes an envelope out of his pocket – something formal, a legal appointment.
‘Well don’t worry. You’re almost there,’ I tell him, handing the map book back. ‘Are you walking or driving?’
‘Driving? Me? No! I came by bus. The man there, he said get off here. He said here was where I had to be. So that’s what I did. And now I wish I hadn’t.’
‘He wasn’t wrong, though. You’ve just turned down too early. You want the one parallel to this, over there. You can cut through that little alley if you’re pushed for time.’
‘Are you sure?’
‘Yep. Absolutely.’
‘I can’t afford any more mistakes.’
‘You’re good,’ I say. ‘You’ll be fine.’
‘Righto then. Thanks for your help.’
He gives me a broad, quick smile that seems more like a mechanical expression of the tipping back of his head, then taps me once on the shoulder with the map book, and strikes out for the alley.

on the stump

so let’s have a standing ovation
a generous pause for applause
from the thousands of windows and doors
overlooking this particular operation
okay
are you ready?
for the one, the only
the Original of the Species
the divine old timer
with the snappy one liner
the blade in the brocade
waving from the cock-end of the motorcade
the gorgeously adorable
uproariously deplorable
spray-can orangutan,
mr muscle in a suit
the man who put the F in faith and the T in truth
he’s so outrageous he’s IN
he didn’t begat he begin
Your leader!

you sir? yes, you.
glad you picked him?
give us your number, we’ll send you a pic of his dictum
how’d you like ten minutes on the dark side of the man
with a steady-cam, following him to the can and back
no? doesn’t float your stack?
Suit yourself. Go ahead. Re-boot yourself.
we’ve got time to kill and the hearts to do it
you had a vote and you blew it
accept it, it’s destiny
anything else is mutiny
yeah? you think
I’m sorry you feel that way
(hey! Hades in the shad-ees
whyn’t you help our friend here see the error of his ways
maybe some mindfulness technique
give his timeline a tweek)
dr google will see you now
that’s a good one
but let me tell you
it’s not all disney princesses and military successes
sometimes you just gotta take stock, you know?
have some time out,
see what all the screaming’s about
all those hilarious failures
the love affairs, mail scares and hail mary’s
the half-witted, two-faced, congressional fairies
why’n ya take a look at this sometime?
know who that is?
little jack horner, crawling back to his corner
thumb dripping plum juice and crack
having a happy-hour heart attack
waking up on the mortuary floor
tip-toeing to the back door
denying all knowledge
hey jack? where d’ya learn to act like that?
ronald mcdonald college?

okay, so

take a moment

and breathe

you don’t need to tell me which way up is,
I’ve been around the block a few times
I’ve kissed a kennel load of puppies.
I know which way the wind’s blowing
I’m tired of all this bitching and moaning
and by the way, just so you know
I’ve been following you from the get-go
man – you’re in so deep
you’ll need a submarine to get to sleep
you’re sub-prime, all the time
you’re turkey without stuffing
you’re ninety-nine percent of nothing
so suck on that for a minute whilst I get myself ready
and you – hold the camera good and steady
people? you never get a second chance to make a first impression
the rest is strictly for confession

musetta

‘Mexican liqueur. Seven letters. Beginning with T.’
‘Tequila?’
‘Is that a liqueur?’
‘It’s made from a cactus. Does that count? Anyway, I can’t think of any other specifically Mexican drinks. Apart from Dos Equis.’
‘What on earth is Dos Equis?’
‘A beer. I think.’
‘Well. Let’s go with tequila then, shall we? And see how we get on…’
Marilyn had a fall in the early hours and tore her arm. She’s busy filling in the crossword whilst I’m delicately cleaning the wound, soaking it in saline, gently replacing the skin flap as best I can, then patting the area dry ready for the steri-strips. Her version of events was that she stumbled over some shoeboxes – no mention of the copious amounts of whisky she’d put away in the hours leading up. If she sees the irony in our conversation about booze, she doesn’t show it.
‘Oh I’m terribly sorry. I misread the clue,’ she says. ‘It actually says Mexican liquor. These glasses are absolutely no damned good at all.’
‘Definitely tequila then.’
‘…which makes one down agora. Which fits! Well done!’
Marilyn is a high-functioning alcoholic. She has a beautiful house in the centre of town, filled with paintings and books, sculptures and peculiar antiques, everything brilliantly lit by the sunshine that positively bounds in through the open patio doors.
‘You have a lovely house,’ I tell her, applying the first layer of dressing.
‘That’s sweet of you,’ she says.
‘How long have you lived here?’
‘Too long. But you know, when Teddy and I moved here in the seventies, it was a different street altogether. Everyone knew each other. It was all terribly friendly and interesting. But now it’s simply overrun with cars, no-one has any time for anything, and the only contact you have is with the postman. Speaking of which…’
Keeping her bad arm as still as she can, she rummages around the clutter on the table and produces a Royal Mail missed delivery card.
‘Look at that!’ she says. ‘Sorry we missed you! What on earth do they mean? Sorry we missed you! I’ve been in all blessed day! I simply fail to understand how they could have crept up the front steps and dropped that through the letterbox without me hearing a thing. Honestly, they must be employing cat burglars or something. Or maybe he ties rags round his boots. It’s enough to drive you absolutely insane!’
‘You’d think he’d want to drop it off, though, just to lighten his bag.’
‘Lighten his bag! I’ll lighten his bag when I get hold of him.’
‘Almost done’ I tell her.
‘Smashing,’ she says, lowering her glasses from the top of her head back down on to the tip of her nose, as she goes back to the crossword.
‘Fifteen across. Famous Bohemian. Beginning with M.’
She snorts.
‘Well – I’d be very tempted to write Marilyn – but unfortunately it ends in an A’