A PARAMEDIC'S DIARY_Life and Death on the Streets Read online

  When the police got their Control to check the details again, they discovered that the call had originated outside of London. The hoax was confirmed when one of the hostel staff pointed out that, although we had a potentially suicidal female, this was an all-male hostel.

  Sometimes hoax callers have an even more sinister agenda. A few years ago, a Bristol crew was pelted with stones by a gang of youths who had called 999 claiming a boy had fallen down stairs and then lay in wait for them at the scene. Others have been threatened with guns, knives and fists. Quite why anyone would want to do this is beyond me.

  ABUSE: It’s bizarre. We only exist to help people (and sometimes even save their lives). You’d think that everywhere we went there’d be grateful punters patting us on the back and doing whatever they could to help. Sometimes it is like that. Unfortunately, a lot of the time it’s not. We get lots of abuse. All of it is supposed to be reported (there are forms to fill in) but since it ranges from something as minor as a swear word tossed in your direction to an outright physical attack, only the more significant events are ever reported. Otherwise, we would be filling in forms almost every shift and certainly every weekend. Nowadays, we wear ballistic stab vests, which says something. I’m told they will stop a .357 bullet, though I wouldn’t like to prove it. But they will stop knives and you hardly feel punches and kicks. We get punched and kicked a lot. During the summer season, when everyone gets tanked up outside, and over Christmas, it happens every week. It’s almost always drunks.

  We all get these ‘unknown caller, unknown problem, please investigate’ calls; most are thoroughly mundane and only a few of those I’ve received are worth talking about. Most of them result in a short area search, a bit more paperwork than is necessary and a frustrated paramedic or ambulance crew. Of course, some of them cost lives. The odd one shows a bit more thought and deserves a mention for the sheer audacity of the perpetrators (though that doesn’t mean they don’t deserve locking up for a month or so).

  A few years ago, when I was working at another station, we were called to a ‘dead child in the street’. It was about ten o’clock at night and quite dark when we arrived at the small residential estate. There were two young police officers standing over what looked like the lifeless body of a young child. It was dressed in a tracksuit and a bright red jacket, and was lying face down in the gutter. There was a pool of blood around the head.

  My crewmate, who was attending, got out of the vehicle and went over to check it out. I followed behind and saw that she was about to try for a response from the person on the ground. Then she gave it a funny look and grabbed the head, pulling it up and forward to reveal the ‘child’ underneath.

  It was a dummy.

  The kids on the street, no doubt watching from the shadows, had created a beautifully realistic corpse, with a face drawn on a cardboard ‘head’ attached to a teddy bear’s torso. The legs and arms of the tracksuit had been stuffed with socks to give it a realistically human shape, and it was wearing a pair of Nike Airs. It was very effective, especially in the half-light of the street lamps.

  The blood, as I discovered when I touched it with my gloved hand, was tomato ketchup.

  The kids had dumped it on the pavement and then called the cops. The two officers had shown up but hadn’t even bothered to touch it to investigate (they were wary and wanted us to do that for them). Unfortunately, when my crewmate showed them what it was they had to admit that they’d already called CID and were waiting for them to arrive. I’ve never seen redder-faced police officers, and I always wondered what the Detective Inspector said to them when he got there.

  We took the offending article back to our ambulance station and hung it up on the wall as a reminder. Over the next few weeks it slowly disappeared as parts of it (the clothing was new and of good quality) were taken away by crews.

  Not all timewasting calls are made on purpose. One little girl phoned 999 to complain that her mum had forgotten to feed the cat. You’d have to have a heart of stone not to laugh at that.

  SEEING DEAD PEOPLE

  SOME PATIENTS ARE more memorable than others, regardless of age or background.

  I remember one lady very clearly: she was a lovely little Greek granny in her 70s. I met her at St Bart’s Hospital - she had cancer and she needed conveying elsewhere for an MRI scan. As I attended her, we chatted and laughed; we just got on very well and it was almost like I was her long-lost grandson or something. I’d meet her from time to time, when I was doing patient transfers, and she always had a big grin and a wisecrack or two.

  I mention her because I’d seen her at St Bart’s one afternoon, and that night my then boss said he wanted to take me down to the morgue. I hadn’t been exposed to death, and he thought it would be a good idea for me to go and sit in there and look at dead people. It sounds morbid, and no-one relishes it, but death is an occupational hazard and your first corpse is one of the things you most want to get out of the way when you start working in pre-hospital care.

  Still, I was nervous, obviously, and I had this strange fear that I’d see someone who was dead wake up. Anyway, I knew it had to be done and I wanted to get it over with. We walked past a number of shrouded figures, and then he said, ‘Do you remember this person?’

  He had a big grin on his face as he pulled back the sheet. It was my old Greek lady, lying there, eyes closed, looking for all the world as though she was just asleep. I had seen her three or four hours earlier, full of life, and we’d had a good chat. No hint that she was going to die. Now here she was. It was a kick in the teeth, and I still think it was the cruellest thing ever done to me, considering how well I had been getting on with her and how suddenly she had gone.

  ‘ATTENDING’: With ambulance calls, one person drives and the other ‘attends’ the patient, and actually treats them; the following day, you swap roles.

  After that, trips to the local hospital to watch post mortems became a regular event for me and some of my colleagues. Not only did my fear of seeing dead people eventually evaporate, but my knowledge of real anatomy increased. It’s a mile off from talking about the human heart and how a heart attack affects it to actually seeing one being removed from a person’s chest, hours after they have died, and looking at the scarred evidence of a myocardial infarction.

  MYOCARDIAL INFARCTION, or ‘MI’, means heart attack. It describes the death of the heart muscle (not all of it, but a part of it) due to lack of oxygen as a result of ischaemia (lack of blood flow, meaning little or no oxygen is being delivered). The word 'infarction' comes from the Latin 'infarcire' meaning 'to plug up or cram,' and it refers to the clogging of the artery that results in a lack of oxygen to part of the heart muscle (the myocardium).

  Myocardial means 'of the heart muscle'.

  Interestingly, the only pink lungs you ever see belong to relatively young people. Smokers or not, the lungs of all the adults I’ve seen being dissected are blackened and sooty from the everyday pollution we live with. The pathologists will tell you they rarely see good quality lungs, even from those living in the countryside.

  Over the years (and that first exposure to death was more than 15 years ago now), I’ve become accustomed to seeing corpses in various stages of decomposition. The dead don’t unnerve me, but the surprise of finding them does. Even today, a call to a ‘person trapped behind locked doors’ with a history of not having been seen for days (or even weeks) can give me the creeps. I know I’ll have to go into the house and that I’ll probably find them dead somewhere. There’ll be a terrible smell and the place will be buzzing with bluebottles. Every room becomes a horrible adventure.

  I went to a call like this with a colleague a few weeks ago. The woman hadn’t been seen or heard of for a few days and we had reason to believe that she might need urgent emergency help, so we decided to kick the door in. (We asked her relatives for permission; they were standing anxiously by, as was a gaggle of curious neighbours and her local church minister, who was worried about her lack of attendanc
e at the recent Sunday service.)

  My colleague gave the door a couple of hefty kicks, in it went and so did we. We looked in every room and eventually found her in the bath - dead. A little trickle of blood had escaped her mouth and her head hung across her shoulder as if she’d fallen asleep. There was no water in the bath; it had either slowly leaked out through the plug or had never been put in, but that didn’t matter to her now. The police arrived shortly afterwards to take over the scene, checking for evidence of foul play or forced entry. The front door was the only thing that showed entry by force and we were the culprits.

  The grief of relatives can be overwhelming to witness. More often than not there’s a quiet, muffled sobbing going on in one of the other rooms as you inspect a corpse for confirmation. Sometimes you get a lot more emotion than that.

  I was with a crewmate on a long and very busy night shift a while back when we were called to a ‘suspended’ - as in between life and death, not breathing, no pulse, in cardiac arrest. ‘Suspended’ means someone thinks there’s a chance we might be able to save the patient by starting CPR when we get on scene. Unfortunately, this is sometimes down to wishful thinking, as it was in this case. The man was on the floor of his bedroom and had been dead for at least an hour.

  CPR stands for cardiopulmonary resuscitation, an emergency medical procedure for victims of cardiac or respiratory arrest. Blood circulation and breathing are stimulated artificially by chest compression and lung ventilation. The idea is to try to maintain a flow of oxygenated blood to the brain and the heart, delaying tissue death and extending the window of opportunity for successful resuscitation using defibrillation and life support systems.

  He’d rolled in after a night of drinking with his best friend and lodger, a young, red-haired man whose face I will never forget. He’d sat up with his wife and the red-haired man until about 2am, then, feeling a little worse for wear, had gone to have a lie down in bed. Some time had passed and the wife had got fed up shouting for him to come and get something to eat. She’d gone up into the bedroom and found him lying very still in bed. Either she couldn’t work out what was going on, or she’d gone into immediate denial, but she’d asked the red-haired man to check him. He did and fled the room to call an ambulance when he realised his mate wasn’t breathing.

  Following instructions given over the phone by the call-taker, he had dragged the man off the bed and tried to carry out CPR but was woefully unable to do it because he didn’t fully understand the instructions and his emotions weren’t under control.

  When we arrived, he virtually pulled us into the bedroom and then left to comfort his mate’s wife - widow, now - in the front room downstairs. She didn’t want to come near us in case we told her something she didn’t want to hear... I understood that fear. We checked the man’s vitals and found that he had none: he had been on the floor for some time and was purple plus. He had a long history of liver disease and a dubious cardiac health record and, anyway, he was already stiff at the fingers and around the face. CPR would be useless. The decision was made not to attempt resuscitation.

  We went into the front room and found the young man sitting in tears on a chair. The new widow was pacing the room and looked out of her head. We broke the bad news to them as quickly and softly as humanly possible.

  ‘There’s nothing we can do for him, I’m afraid,’ my colleague said.

  That single sentence provoked a long and anguished wail from the woman and a sudden emotional collapse in the red-haired man. We had to stay with them for quite a while; we’d requested police, which is normal procedure in these cases, but they were delayed and couldn’t guarantee being with us for several hours. During that long wait with the two closest people in the dead man’s life, the other guy’s eyes never dried. He looked like a scared puppy and he kept repeating the same thing over and over again: ‘What am I going to do now?’

  Apparently, the older man was his only friend and he had nowhere to live but this house. The woman seemed to shun him and I got the impression she somehow blamed him for her husband’s death. When she eventually calmed down, she left the room after asking if she could see her husband again. I went with her; she kissed him on the forehead and lips. It was agonising to watch. Real grief reminds you of your own loved ones and I kept thinking about how horrible this will feel when it happens to me, as it inevitably will.

  I left her alone with him for a few minutes while she said her final goodbyes. Then she came back into the front room and never spoke to any of us again after that.

  The cops arrived soon afterwards, and that started a fresh torrent of despair. We left, the police officers not knowing where to look or what to do.

  * * * * *

  I travelled a long way into south London for another ‘suspended’, but, again, there was no work to be done. An ambulance was already on scene when I pulled up outside the small terraced house. The front door was wide open and people were milling around in the hallway. One of the crew came to meet me and just shook her head. I went upstairs to see what I could do, if anything, but the man was dead in his bed, and had been for a while. He was stone cold and rigor mortis was just creeping in to his peripheries.

  The man’s wife was in the room, along with her daughters and a son.

  ‘His eyes are still open,’ she said to me

  ‘Do you want me to close them?’ I asked.

  ‘But his eyes are open,’ she repeated.

  I went over to the bed and together we closed his eyes for the last time.

  Then she said the same thing that many others have said in this situation. ‘What am I going to do now?’

  And she began to cry. I put an arm around her shoulder until a relative took over. I left the house and the crew stayed behind to complete their paperwork and manage the family’s grief until the doctor or police arrived.

  ‘PURPLE’: We call the recently dead ‘purple’ and those who have been dead a while ‘purple-plus’. The morgue is referred to as the ‘purple annexe’.

  Last month I answered a call for a ‘female, possibly trapped behind a locked door’. I raced round to the address and the police got there a few moments later. It turned out the ‘woman’ was actually a male called Dave and his brother Andy was waiting there anxiously for us to arrive. He’d knocked - and then hammered - on the door to the flat and got no response, so he’d then visited his brother’s few regular haunts and found no sign there either. Dave hadn’t been seen for three days now, so Andy had rung 999.

  I looked through the letterbox and sniffed the air inside: there was no unusual smell, but a light was on in the front room. I shouted through but there was no reply, just a dead quiet. The door was very well secured and the police officer had no luck trying to kick it in. One of them went to fetch the ‘key’ - a battering ram used to smash down doors - but while he was gone the brother unscrewed a piece of plywood covering a small, broken window. The other police officer, who was a slip of a girl, was able to squeeze herself in through the gap and open the door from the inside. I made my way in, and the brother followed. He noticed that Dave’s inhalers were still on the table, along with other personal effects that would normally be with him if he went out, so that didn’t look great. We went from room to room, me expecting to find a corpse in any one of them. We’d checked the living room, the kitchen and the bedroom, and the brother started to relax. ‘Thank God,’ he said, with evident relief. ‘He must be out somewhere.’

  But he spoke too soon. We were all heading out of the flat through the small hallway when I noticed the bathroom door ajar. I’d assumed it had been cleared, but I looked through the gap between the door and the wall anyway. Dave was inside, sitting on the loo. I signalled to the police officer that I’d found him and that his brother should be kept back for a moment. I went in and checked him. He was pulseless, cold and stiff.

  Andy pushed past me and fell apart. He cried all the way out of the flat. I felt sorry for him, but I couldn’t help him and I had nothing to offer.
He called his wife and told her what had happened, sobbing through the entire call, trying and failing to keep his composure. He was still in tears when I left.

  You try to be as respectful as possible, obviously. Occasionally, something embarrasses you. I was called to confirm life extinct on a male who had been found by his regular carer and neighbour. The guy was sitting in a chair in front of the telly, a half-opened nebuliser in his hands and cans of beer strewn around the floor - one of which was waiting to be opened.

  The carer had let himself in to give the man some breakfast, only to find him sitting upright, for all the world looking as though he was watching the birds in his garden. He was asthmatic and had emphysema, and had a home oxygen system and a portable, mains-powered nebuliser compressor. It looked as if he had suffered an attack and had attempted to give himself some salbutamol but that at the crucial moment his electricity meter had run out of credit and the power had failed. The compressor stopped working and he had gone, very quickly, in the middle of trying to save himself.

  As I sat there, my service mobile phone rang. Some joker had reset the ring-tone to the sound of a rooster.

  EMTs: Emergency Medical Technicians. They are highly-trained and skilled, and make up most of the population of the ambulance service, but they are not paramedics; paramedics have more advanced skills, and are qualified to use invasive techniques and drugs which EMTs are not. All paramedics were once EMTs, and many EMTs will go onto become paramedics.

  It doesn’t always end in tears. Last year I went to a house where the tenant hadn’t been seen for 24 hours and his dog - which was large and known to be highly protective - was barking relentlessly inside. The police were there and an officer with a mirror on a stick had cautiously crept up the stairs and located the animal with the makeshift periscope. It was on the bed, staring angrily right at him, and it had bounded off, growling, sending him scuttling back downstairs. He’d seen no body, but it seemed a fair bet that the owner was probably unconscious or dead on the bedroom floor. If that was the case, the canine protector wasn’t going to let anyone near him; we could all hear it panting and growling to itself at the top of the stairs. Nervously, I checked the fit of my stab vest and then thought, ‘Who am I kidding?’