I’ve worked for the ambulance service for thirteen years, eleven of those as a paramedic, and the last four of those leading a dual life as an author. My books tend to resemble my world – medical themes, with police, doctors, chaos, and violence – and I’ve always tried to keep them on the right side of realism. Bearing that in mind, none of my leading ladies are uber-heroines, those striding, muscle-ripped superwomen so beloved of cop/doc fiction, and the central pair in the Dark Peak series are no different. Sanne and Meg are bright, intuitive, and good at their jobs, but they get knackered, get puked on, laugh at the wrong things, and fuck up just like any of us. No Good Reason and its sequel, Cold to the Touch, are without a doubt the most personal books that I’ve written. They don’t just resemble my world, they pretty much are my world, so I thought I’d give prospective readers an idea as to what twelve hours in my stinking old work-boots involves…
6 p.m. Monday
I’m tired before we even sign on. We’re right at the end of our four-week shift pattern, and I’ve worked days all weekend. I’d fallen asleep on the sofa at 9 p.m. Sunday night, been poured into bed by my wife, and slept straight through for twelve hours. It hasn’t helped, though. My brain feels like porridge and my short-term memory is next to nonexistent.
The day crew hand over to us on station, tell us what they’ve used (“fuck all”) and what the ambulance needs (“just a willing crew”). We sign on a couple of minutes later. Our regular vehicle is being serviced, so we’re on a pool motor with no radio to sing along to, no mobile phone, and a reluctance to change gear. We’re immediately passed a job: ?Meningitis at the local Integrated Care Centre. I bet my Work Wife a quid that it’ll be a kid with a simple viral infection. Unsurprisingly, she isn’t tempted.
Our patient is a rosy-cheeked toddler with a high temp and absolutely no symptoms of meningitis. He has a small, non-blanching blotch behind his ear that his dad noticed two days ago. If that really had been a sign of meningococcal septicaemia, he’d be dead by now. We transfer the child to Accident and Emergency where the triage nurse rolls her eyes and directs us round to Paediatrics.
As soon as we clear, we’re given a purple response – the most serious dispatch code (cardiac/respiratory arrest) – that’s subsequently been downgraded by the paramedic on the Rapid Response vehicle. The patient is an Oscar-worthy pensioner throwing herself around on the sofa and hyperventilating. Her family had met the RRV in tears, convinced that she was dying. She walks out to the ambulance unassisted, seemingly afflicted by the dire medical condition known as PVS (Poorly Voice Syndrome). In deference to the Work Wife, I put my foot down on the way in, glad that I’m driving.
My WW and I swap about after every job, so I attend the 84-year-old Asian chap with metastatic prostate cancer who’s cared for at home by his family. He’d stopped swallowing earlier in the day, and his son is struggling to push fluids. When the emergency doctor didn’t show up at 8 p.m. as arranged, the son had phoned 999. The patient is in a poor state: emaciated, doubly incontinent, hypotensive, and agitated. He clings to my hand in obvious distress. As we’re wondering whether moving him will actually kill him, the doctor shows up and tells us that a new medication the patient has recently started might make him “pick up a bit”. It’s hard to think of an appropriate response to that, so we focus on transferring the patient to the vehicle, relieved when his breathing grows shallow and more irregular but doesn’t stop. We pre-alert the hospital and take him straight into Resus. The rest of the shift is so manic that we never get a chance to check up on him, but it’s unlikely that he made it back home.
Monday nights are typically busy, and this one is no exception. The A&E is packed, all the cubicles are occupied, and there are no beds on the wards to admit patients to. Government targets dictate that patients should be admitted or discharged within four hours, a target that’s been missed nationally for months. One of our regulars grins when I greet her by name. I’m amazed that the smell of her hasn’t been enough to clear the waiting room.
As there’s no sign of us getting an official break, the WW and I treat ourselves to chocolate orange digestives and tea from a flask as we wait for our next job to be sent through. We used to be able to get a brew at the hospital, but the management long since stopped that. Still, it’s a poor paramedic who can’t get themselves a hot drink from somewhere, and most of us travel equipped now.
Two more red (immediate threat to life) responses follow. The first is a pregnant 27-year-old who’d vomited a single streak of blood. She walks out to the ambulance and her husband follows in the car, a scenario so commonplace we’ve stopped asking why they didn’t simply make their own way to A&E. No one in the UK is charged for calling an ambulance, so we’re often used as a free taxi service, and there’s a popular misconception that going in with us gets a patient seen quicker.
The second red is for a male complaining of “rocks dropping in his ears”. He’d phoned a national helpline for advice and didn’t want an ambulance. From his bed, he directs the WW to the kitchen drawer where he keeps his meds, and then yells at her for “rooting around”. He refuses to go to A&E, but we still have to take all his obs and complete paperwork before we can leave him at home.
It’s 11:21 p.m. and we’re en route to job #6. The WW asks for her glasses, announcing “Ah, I can see!” as she puts them on. I tighten my seatbelt a little. She’s been driving on blues for the last ten minutes.
We’ve slowly been dragged further out of our area all night, and we’re now 20 miles from our base station. The parents of our 16-year-old overdose have been told that her choice of tablets wasn’t life-threatening and advised to take her to A&E in the car. They did exactly that, but we’ve been sent anyway. We clear on scene, feeling like pillocks.
Job #7 is a 72-year-old female who “had chest pain earlier”. Earlier turns out to be six hours ago, when the doctor at the care facility had given her an aspirin and advised blood tests. Those bloods now indicate the patient had had a heart attack and, in a turn of events so backwards it’s mind-boggling, we’ve finally been called to take her to A&E. “Oh, we’ve had an outbreak of Norovirus, so she’s in isolation,” the nurse on the unit tells us. I promise her that I won’t lick anything.
The A&E we go to is so full that there are patients lying on beds by the nurses’ station with no privacy and little in the way of dignity. None of the staff bat an eyelid; it’s been like this all winter.
At 1:45 a.m. – almost eight hours after signing on – we land back on station for our first break. I eat half a tea-cake and some fruit, my eyelids drooping the instant I sit down. After exactly 30 minutes, our radios go off and we head out again to a 75-year-old female: “leg swollen after trapping it in a car door”. At least, that’s the information we’re given. On our arrival, she tells us the injury occurred eight weeks ago and she’d become panicky because her cellulitis was burning. It’s a typical 3 a.m. witching-hour call, and we spend half an hour on scene chatting to her. I make her a hot water bottle and a mug of apple tea that smells like old socks, and we leave her settled and reassured, with an appointment to see the district nurses in the morning.
Upon clearing, we receive our favourite message from Control: RTB – Return to Base. We’re both asleep within minutes of hitting station, the WW so insensible that she fails to hear the mouse rioting beneath the computer desk and mistakes her radio going off for her alarm clock, attempting unsuccessfully to snooze it.
Our 5:15 a.m. emergency will be our last of the night, and it’s local, so I tear-arse to it to stop us being diverted to anything out of area. Our patient is a drunk male who’d tried to walk to his sister’s to post her a birthday card, but decided to take a nap in the road. He’s lucky someone spotted him; the road is unlit and notorious for joy riders. There’s nothing wrong with him, but we take him to A&E to warm up and sober up. He’s pleasant enough, hasn’t wet himself, doesn’t try to clobber us, and is able to walk. Small victories, but victories all the same.
We clear at the hospital and make a mad dash to station, launching keys and radios at the day crew before we stumble to our cars. I get in bed at 7 a.m. and wake at 10:15. By 12:30 p.m. I’m still wide awake and so tired that I’m in tears. I have less than five hours before I have to go back in and do it all over again.