Copyright

4th Estate

An imprint of HarperCollinsPublishers Ltd

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London SE1 9GF

www.4thEstate.co.uk

This eBook first published in Great Britain by 4th Estate in 2017

Copyright © Kit Wharton 2017

Kit Wharton asserts the moral right to be identified as the author of this work

A catalogue record for this book is available from the British Library

Cover photograph © mediaphotos/Getty

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Source ISBN: 9780008188634

Ebook Edition © January 2017 ISBN: 9780008188610

Version: 2018-09-13

Dedication

For Ren and Fin

Contents

Cover

Title Page

Copyright

Dedication

Disclaimer

1 Just Another Shift …

2 Communication

3 Frequent Flyers

4 Emergency Admissions

5 Fear

6 Alcohol

7 Arguments

8 Children

9 Mental Illness

10 Unsafe Discharges

11 Luck

12 Road Traffic Collisions

13 Sex

14 Suicide

15 Mistakes

16 Heroes

17 Timing

18 Bodies

19 Those Left Behind

20 Pillars of the Community

21 Wonderful People

22 Children (Again)

23 The Best Job in the World

Acknowledgements

About the Author

About the Publisher

Disclaimer

This is a journal I’ve kept since joining an NHS emergency ambulance service trust somewhere in England in 2003. And an explanation of why I joined in the first place.

It’s the best job in the world. I’m still learning. Often about people. If you even think you know them, you don’t know them well enough. What did Robert Capa say? If your pictures aren’t good enough, you’re not close enough.

I should point out I’m not a doctor or nurse or even a paramedic. Pretty much the whole NHS is better qualified than I am. I’ve said to many a patient: no point asking me – thick as a whale sandwich – you might as well ask the cat. I just take you to see the right people. I should also point out I’m not a professional writer. If you’re expecting Marcel Proust you might be disappointed. The journal is not endorsed by any ambulance service and no views expressed should be taken as those of one. Nothing should be taken as medical advice. All mistakes are my own. And some procedures and practices may have changed since I wrote about them.

Nothing has been invented or exaggerated – I wish some of it had, and actually I’ve toned some of it down – but names, locations, dates, sexes, medical conditions, characters and other details have been changed, disguised or amalgamated to protect anonymity.

One more caveat. A ‘normal’ job would be: called to a patient, say, fallen over. Patient is conscious or unconscious, and has no injuries/some injuries/lots of injuries. Patient is checked out and left at home or taken to hospital, where patient makes a good recovery/a partial recovery/unfortunately dies. The sort of job we do every day. Thousands of times a day.

The following are not normal jobs.

And you may need a strong stomach for a few of them …

1

Just Another Shift …

All human life is here, as the News of the World used to say. On this shift, even more than usual.

Robert, Edward and Davina

It’s the sunny evening of a bright spring day, but not in the mind of the next patient. We get a 999 call to Robert, in his fifties, with a long history of mental illness.

Robert is a tall thin man, with sunken eyes. He’s hearing voices in his head, telling him to hurt himself, or someone else. He’s tried to hurt himself in the past – and succeeded. You can see the scars all over his body.

Because of the nature of the job, the police come along and we meet them at the address. It’s a pretty cottage, isolated down a track, with a lovely view over fields of corn and only the hum of the motorway to spoil things. But the garden tells you things are not right. There’s an old sleeping bag in the middle of the grass, lots of other rubbish, and empty bottles and cans everywhere. No one’s exactly been pruning the roses. Pity. Wouldn’t mind living here myself.

But I wouldn’t want what’s going with it today.

We go in with the police to find a male lying in bed, bottles all over the floor and the room filthy. Dirty clothes and faeces everywhere. The patient’s eyes stare into another world where you wouldn’t want to go. There’s an empty litre of off-brand gin by the bed – he’s drunk it this morning – and a large kitchen knife. The WPC steps forward and removes it.

—We won’t be needing that, will we?

She leaves us. I’m ‘attending’ this job, which means I deal with the patient. My crewmate stays outside with the police. I talk to him gently for a bit just so he can get used to me and not feel threatened.

I ask whether he’s happy to go to hospital.

—Yes.

—Super. Well let’s get some trousers on, shall we?

(Usually a good idea to keep it bright and breezy.)

—OK.

He gets up and crosses to the cupboard in the corner. Out of it – wordlessly – he pulls a bloody great machete, maybe three foot long, which he looks at and weighs in his hand as if he’s buying it in a shop. No sign of any trousers.

Shit.

—I don’t think we’ll be needing that, will we, mate!

I say it loudly, so the police hear and, since it’s all gone a bit pear-shaped, I back out of the room.

The coppers are outside in the corridor. I tell them what’s happened.

—All right. Get outside.

From the front door we can hear the ‘discussion’ that follows.

—Put it down, Robert!

Nothing.

—Put it down!

More nothing.

—Put it down or we fucking spray you! Now!

The police carry pepper sprays and the like, but it’s not good using them in a confined space like this.

My crewmate’s called Valerie. Ten years younger than me, a lot prettier, but twenty years older when it comes to things like common sense. She has that weird and annoying female gift, the ability to be right, about everything, all the time.

—We don’t want to get involved in this. That stuff’s horrible.

She drags me out.

Within a minute there are sounds of a scuffle and the handcuffed patient comes out with the two police either side of him. Under the anaesthetic of a litre of gin, Robert is unaffected, but the two coppers are suffering terribly, coughing and wheezing and spluttering, and the patient’s holding them both up as they cling on to him like children.

We grab the patient and bundle him into the ambulance with a seatbelt on him, where he sits admiring the scene, while we put oxygen masks on the police who are sitting on the bonnet of their car and trying to breathe again.

It takes a good twenty minutes for the spray to wear off.

Then we take all three down to A&E.

Later in the shift.

Somewhere in England, not sure where. Don’t really care, frankly. Busy shift – aren’t they all? – but this one’s a killer. Cold, foggy and damp. Nine in the evening. Exhausted and still three hours to go.

We’re driving through the middle of nowhere.

We see about the tenth fox of the night. And a badger. Val thinks she’s seen an owl, though she may be hallucinating. You can’t do night shifts on the road without becoming interested in wildlife.

We get a 999 call to a male, late twenties, with abdominal pain. The address is a council flat in a block, quite respectable, a frightened-looking elderly couple in the front room. No male, late twenties.

Edward’s their son. They tell us he’s left and gone down the pub – even though he’s barred and it’s closed. Odd. He’s an alcoholic and a frequent caller. Lots of ‘previous’ with us and the police. There’s a warrant out for his arrest – for shoplifting or something.

Wow! How bad can he be? We look at their frightened faces and hazard a guess. Then down outside the pub we find out.

He’s a wreck.

Filthy, stick-thin, with a grey pallor and sunken red eyes. Stinking of urine, vomit, sweat, you name it. Living rough and killing himself as fast as he can. Schizophrenic and alcoholic. He calls ambulances because whenever he gets sober enough to feel anything, his liver and pancreas – collapsing and inflamed through alcohol abuse – cause him agony. Then when he feels better, out of hospital he goes. It’s difficult to know what will break the cycle, except the obvious. I think of the terrified look on his mother’s gentle face.

At least he’s not violent. As we get him on the ambulance the police turn up.

—Is it him?

—Yes. Do you know him?

—Oh yes. Where’re you taking him? He normally goes to the local A&E.

—We’ll take him to our A&E. Give his usual one a rest.

—OK. We’ll come down and arrest him later.

In the ambulance he tells the policeman half-heartedly to fuck off then falls asleep – snoring and peeing himself – on the stretcher. The smell is bad. We set off. Halfway to hospital he wakes up and tries to focus.

—Who the fuck are you?

—Er, I’m the fucking ambulance man. You’re in an ambulance.

—Where are we?

—On the way to D—— A&E.

—Don’t want to fucking go there. I go to L——!

—Well we’re giving L—— a rest tonight, aren’t we?

—No!

He gets out his phone – with difficulty – and dials 999.

—I want an ambulance.

—You’re already in an ambulance! I shout, so the 999 call-taker can hear.

He continues to demand another ambulance, swearing into the phone, then hands it over.

—She wants to talk to you.

I press his phone to my ear.

—You’ve got a right twat there, the call-taker says cheerfully.

—Yes I know.

At hospital we unload him off into A&E. He lasts about two hours there, then wakes up and walks out. The police never show up.

—Bless, says Val.

He’ll probably be back at his favourite hospital tomorrow. Can’t help thinking about his frightened parents in their neat flat, blameless. How the hell did it end up as bad as this?

Anyway.

Even later. Dog-tired. But not bored. Not on this shift.

Seventy-three minutes and twenty-three seconds to go.

The last 999 call is in a dull little town acting as a dormitory for the big international airport nearby. Not much happens here. Supposedly.

We’re off out to a female – fifties – fainted in an art gallery. An art gallery? GP on scene – reports pulse very weak and irregular. Patient in and out of consciousness. The weak and irregular pulse in a woman that young is serious – could be a heart attack. We set off. Can’t help wondering why an art gallery’s open now and what a GP’s doing there.

On scene we’re led through the gallery, which is a large room with – not surprisingly – lots of pictures on the walls. There are at least fifty people in the room – all ages – the men wearing sharp suits and the women made up and wearing very low-cut dresses. Everyone’s standing around the edges of the room, holding drinks and looking rather embarrassed, saying nothing.

Looks like a racy cocktail party gone wrong.

In the middle of the room – with no one anywhere near it – is something that looks like a tan leather gymnasium pommel horse with lots of belts, buckles and straps attached to it.

What is this place?

We’re led to the patient, who’s been moved to a side room. As we enter, the woman who turns out to be the GP – also in a low-cut dress – rushes past us and out of the door without saying a word.

It’s not a heart attack, thank goodness. Davina’s a nice lady, polite, with short blonde hair. She’s wearing a black T-shirt, a black leather skirt and enormous black boots. She’s making a good recovery – pulse is coming back strong. There’s been no chest pain or shortness of breath. Her ECG, the electronic picture of the heart that we can look at, looks good.

As we assess her we see that her back and shoulders are covered with hundreds of tiny scratches and welts, as if she’s been dragged through a rose bush ten times.

Val shoots me a look. What the fuck is going on here?

The patient’s up for the night with a friend – another buxom lady in another low-cut dress.

—Has this ever happened before? Have you fainted before?

—Yes, when I’ve been running or exercising hard.

—But you’ve not been exercising hard tonight?

—Well … no.

She starts to look embarrassed and the penny finally drops.

This is an S&M club. Sadomasochism. Is that right? (Not even sure how to spell it.) Our patient is the ‘victim’ (presumably willingly), tied to the pommel horse somehow and thrashed to buggery with God knows what while everyone else looks on sipping their drinks politely. Nice. Not my cup of tea and very strange, but we’re far too polite to comment. Takes all sorts. Didn’t realise women did this sort of thing. Didn’t really realise men did it, for that matter.

I try to phrase things delicately.

—Would it be fair to say your pulse might have been a little elevated by what was going on tonight?

—Well yes. Maybe we were going at it a bit strong.

—Maybe go at it a bit less strong next time?

(You should always give patients advice on how to manage their condition.)

—Yes, I think I will. Maybe give it up altogether.

Off we go.

The hospital – like a lot of them – appears to have been designed by a child with attention deficit disorder, the architect having an epileptic fit. Departments, corridors, lifts and wards all over the place, in no order at all. To get from one side to the other you have to take two different lifts, and cross a street. You could lose an army in here.

We take the patient to A&E, and hand her over to Fatima, one of the regular triage nurses. Triage nurses are usually the first hospital person the patient sees. Most are warm and welcoming and lovely. Fatima’s … a bit different. She looks a little like Oddjob from Goldfinger. A large lady, ever so slightly menacing, she manages to look expressionless and disapproving at the same time – both of us and of the patients. (I’m sure she’s lovely really.) I explain the faint, the irregular pulse, and as delicately as I can, the S&M thrashing. It’s a bit like being a lawyer, in court defending a client before a judge. Fatima just stares, then writes unwell patient on the triage form.

All human life, as I said.

On the way out a colleague shouts cheerfully:

—Don’t use the coffee machine! One of the NFAs (no fixed abode) was taking the spoons out earlier, licking them and putting them back!

Nice. (Makes a change from drinking the alcohol gel I suppose.)

End of shift and good night.

When the going gets tough – we’re out of here.

We go back to the station – a huge, cavernous building with two sets of double doors that you drive in and out of. Ambulances come in one end and out the other, like sausages. Old and a bit dirty. Occasionally a pigeon flies in and we have to shoo it out. The station tells you a bit about the service. There are pictures on the walls of ambulances parked in formation, back in the 1970s and 80s and 90s. In the days when ambulance crews washed the ambulances, kitted them out, cleaned the station, even sat down and had a meal together. Nowadays, we’re so busy that teams of people do all that for us – we collect our ambulances at the start of the shift and we’re off out and might not see the station again until twelve or thirteen hours later. Though sometimes, on quieter nights, you can open up little cupboard rooms around the station and find old abandoned equipment and stuff in them, decades old. There’s probably a body in there somewhere. Or someone living there. Maybe a patient?

I tell one of the bosses about the shift.

He’s a very tall, thin man, slightly frightening and balding, called Len. Ex-forces, in the job a million years. A man of staring eyes and whispered words, unsmiling. Whatever bit of the forces he was in may not have been the Charm School Corps. He’s retired now. Modern ambulance officers are a little more … cuddly, I suppose. He ponders the jobs a few minutes, then gives his stock response to a lot of things.

—Stupid buggers.

—I felt sorry for them, says Val. Especially the one who’s mentally ill.

Len stares at her.

—What d’you want to feel sorry for him for? He’s a nutter.

I get home about midnight – dog-tired – as Jo’s going to bed. The kids who I left too early to see this morning are long in bed and I won’t see them tonight. I pour myself an industrial-sized whisky. There might be another after that.

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?

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