An ambulance person doesn’t always know what they’re getting themselves into. A job appears on the screen, say for example: MALE COLLAPSED ON THE STREET. But there are lots of different reasons men collapse on the street. It could be for a variety of medical reasons, or because they’ve drunk far too many shots. Or they might have been punched unconscious. Or maybe they’ve tripped and hit their head on the kerb. Another call might say: FEMALE FALLEN OVER IN HOUSE. And when we get there, she’s clearly been assaulted. We’ll sit her down and ask whether she wants to talk about or report what actually happened. But we can’t make them.
We might get called to someone who has reported a chest pain and when we turn up, they’ve got a knife sticking out of their chest. Or we’ll be called to someone who can’t get out of bed, and when we arrive, they’ll be a bariatric patient (the medical term for morbidly obese). You can almost guarantee that their flat will be on the top floor and the lift won’t be working.
When I started out in the job, we weren’t provided with any specialist equipment to deal with this, partly because obesity wasn’t as big a problem, partly because society was simply less understanding. So the first bariatric job I went to, I walked into this woman’s bedroom, saw her on the bed and thought, How the hell are we gonna get her out? She must have been 30 stone, at least, so wasn’t able to get up, let alone get down the stairs. But we knew we had to get her to hospital for a blood test pronto, because she was complaining of chest pains. We also knew that our only option was to call the fire service, because we didn’t have the necessary kit.
Despite the difficulties I could see were going to be involved in getting the patient out, we did everything we could to make her feel at ease. Every time a clinician meets a patient, they should introduce themselves. It sounds like a no-brainer, but in the fog of a day’s work, people forget themselves. The patient in question no doubt felt vulnerable and exposed, lying on her bed with nothing but a sheet to protect her modesty. But me saying, ‘Hi, my name’s Dan and this is my colleague Paul,’ hopefully made the situation feel a little bit less intimidating for her. And when the fire brigade turned up, we introduced them to the patient one by one. Being on first name terms removes barriers and makes everyone involved feel more comfortable.
Once we’d broken the ice, I explained to the lady why we needed to take her to hospital and that it was going to be a bit tricky to get her out of the house and into the ambulance. I think I said something along the lines of, ‘It’s going to take some working out, so you’ll have to bear with us. But I’m sure we’ll be able to get you to where you need to be safely.’ You have to be honest, but you can sugar the pill by saying it gently.
We tried to make sure we had our plan worked out beforehand, because we didn’t want to be having urgent conversations while we were standing over her, scratching our heads, huffing and puffing and generally making it sound like a major operation. That’s likely to make a patient feel like they’re putting us out.
As always, we involved the patient in our discussions: ‘What if we do this? Would it be okay if we did that?’ Otherwise, she’d feel like a spare part, as if we’re moving an inanimate object. The key thing to remember in any situation like this is that we’re dealing with a real person, not a piano, and it’s important that they feel a part of their own treatment, rather than a nuisance.
However, the fire service had to use what appeared to be a horse net to lift her off the bed, because they weren’t provided with the necessary equipment either. It took about ten firefighters to carry her out and down the stairs. We removed the stretcher from the back of the ambulance and they replaced it with her mattress, so that she had something to lie on. The fire engine followed us to the hospital, used the net to remove her from the ambulance and I can’t even remember how they got her inside. Some things are best forgotten.
Whatever your views on obese people – and I realise some people don’t have much sympathy for them – that’s no way to treat anyone. It wasn’t our fault, and it wasn’t the firefighters’. None of us had the tools. But every patient should be treated with respect and dignity. And putting someone in a net is not treating them with the respect or dignity they deserve.
Thankfully, things have changed significantly. Now, there are special bariatric ambulances and chairs with caterpillar tracks that carry the patient up and down stairs. We call it the ‘electric chair’, although not within earshot of the patient. That would be one way to finish someone off with a heart attack. Most of the time now we can do the job without having to call the fire service, but the electric chair will only work on wide staircases with not too many turns. If that’s the case, the fire service will get the patient out using a specialist slide sheet, which is a bit more dignified than a net.
But you still hear stories about doors, windows and even walls having to be removed in order to extract a bariatric patient from their house. Some of these extractions are logistical nightmares and can take more than a day, because sometimes supporting systems will have to be put in the house to ensure that everything stays structurally sound and the whole thing doesn’t come crashing down. And you can bet your life the fire service doesn’t put it all back together again when you get out of hospital. You’ll have to get a builder in for that, and they cost money.
Obviously, the main causes of obesity are lack of exercise and overeating. But why is someone not exercising and overeating to such an extent? It’s often a result of medical or mental health problems rather than pure greed. The bigger they get, the less confident they become, so they become prisoners in their own homes. And because of the internet, they don’t have to go out to the shops or leave the house to socialise, so it’s a vicious circle. It’s a crying shame that the root causes of their obesity aren’t spotted earlier. How can society allow it to reach the point where someone can’t get out of bed?
Ideally, there would be more work in communities, people teaching preventive measures, the perils of a bad diet, smoking, too much booze and lack of exercise. It would certainly make our job easier on the body (when we’re faced with bariatric patients, we don’t hang around doing limbering-up exercises, like weightlifters, we have to get straight to it) and it would save the NHS an awful lot of money.
While some people eat themselves to death, others prefer drink. Ambulance people see every stage of an alcoholic’s decline, from their early days on the bottle, when they’re falling unconscious and needing reviving, to when they’ve turned yellow because their liver is starting to fail, to when they’re vomiting blood because of oesophageal varices, which basically means the veins in their oesophagus have ruptured. That’s one of the worst things an ambulance person can see. Me and Paul were on a job once and we turned up to find the patient’s living room looking like a scene from The Exorcist. There was blood everywhere and I could see the abject fear in his eyes, because oesophageal varices can hit you from nowhere. But there was nothing we could do, other than get him in the ambulance and go. I get to see how people from every sector of society live. Some people live in luxury. The vast majority have comfortable, clean, tidy homes. People at the bottom live in total squalor. I’ll walk into a house and there will be mould on the ceiling, floorboards missing, windows boarded up and doors hanging off hinges. And at least one of those doors usually has a fist-sized hole in it.
How some people live is nothing short of tragic. I was called out to one house and when the copper answered the door, he was kneeling on top of a pile of rubbish that must have been 4ft high. We climbed on top and crawled after this police officer, as if we were potholing. We didn’t know what we were crawling over. There could have been needles sticking out, animal excrement and rats sniffing about. We found the elderly lady in what we think was her bedroom, already dead. But what I remember most about that job was the fact we could hear the TV but not see it. That TV must have been on for years, because there was no way she could have switched it off. Just the sound of that TV was probably the only company she had. I found that so very sad.
We once went to an elderly gentleman who was feeling unwell. When we entered his upstairs bedroom, the floor-boards started crumbling under our feet. He reminded me of the guy in the animated film Up, in that his world was literally falling apart around him. I can only assume he’d been walking on the joists for years. One foot wrong and he was gone.
We introduced ourselves and asked what we could do for him. After ascertaining that he needed to go to hospital, we had a chat about his living conditions: ‘It doesn’t feel safe for you in here. Would you like us to talk to someone about your situation? They might be able to help.’ He wasn’t one of those stubborn old people who didn’t think anything was wrong and refused to be told, he agreed with us 100 per cent. No one had offered him the support he needed, and he didn’t have money to repair his floorboards. We decided it was too dangerous to try and get him out ourselves, so called the fire service. They managed to do the job by making sure to walk on the joists, which wasn’t easy.
During our chat, the guy told us that he played dominoes in his local. That gave his situation a different angle. It made me realise that just because someone you meet might seem to be getting along fine, that’s not necessarily the case. They might be living in deprivation but be too proud to tell anyone.
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We’re called to a concern for welfare incident, which usually means someone has triggered a medical alarm or a member of the public is worried about a neighbour. An elderly lady hasn’t been seen for a long time, and a post-man has noticed letters and junk mail piling up inside the front door and flies on the inside of the windows. Understandably, the hulking police officer who arrived on the scene before us suspects the worst, which is why he stands back and waves us in, having managed to gain entry through the back door.
I’ve never seen so many flies in my life; we are literally brushing them aside with our feet as we creep along the hallway. This place is like the world’s scariest haunted house, although I can tell that once upon a time it would have been immaculate. There are nice paintings on the wall and expensive-looking ornaments on sideboards. But it clearly went to rack and ruin a long time ago. There are plates piled up in the sink, mounds of rubbish everywhere and it smells of rotting food and matter. And every time we pop our heads into a room, there is every chance we’ll be greeted by the sight of a decomposing corpse.
Nothing in the kitchen. Nothing in the bathroom. Nothing in the living room. Nothing in the dining room. Which leaves only one more room downstairs. I open the door and we all peer in. We must look like the lads and lasses from Scooby-Doo. In bed is an old lady. She looks about 150. She’s emaciated, not much more than skin and bones, but looks peaceful. Just as I’m thinking, Is she dead?, the woman sits bolt upright and bellows, ‘What are you doing in my house?’
I’m not ashamed to say I nearly shit myself. The burly copper, who is armed response, almost jumps out of his skin and lets out an almighty scream. I’m surprised he doesn’t shoot the lot of us. Now, that would be a story.
The woman doesn’t immediately calm down.
‘Why are you here? Who let you in?’
‘We’re really sorry, but there were letters piling up behind your door. We thought you might need some help. Would you like us to phone social services?’
‘No, I don’t need anybody’s help. Get out of my house!’
The copper, having finally stopped quaking, taps me on the shoulder and says, ‘Come and have a look at what I’ve just found . . .’
I follow him into the living room and on the wall is a Perspex box, covered in flies. Inside the box is a painting and mounted next to it is a letter of authenticity, confirming that the painting is an original Picasso. Jesus Christ. This is a bit of a departure from the artwork we normally see on patients’ walls, which ranges from Lowry prints to posters of Bob Marley smoking a spliff.
We spend a bit more time with the lady and discover that the only family she has is a distant cousin at the other end of the country who she hasn’t seen for thirty years and doesn’t have a contact number for. We have no choice but to leave her in the state she’s in. We can’t forcibly remove her, because it’s not against the law to live how she’s living, nor is it a medical emergency. All we can really do is contact her GP and refer her to social services, although we also make ourselves useful by doing a bit of cleaning and taking some rubbish out.
I did a bit of research on the Picasso and discovered it was part of a series. The last one sold at auction for millions of pounds. What does that say about money? Last I heard, the lady was still with us, lying in that bed, day after day, night after night, with not a friend in the world. She had all the money she ever needed but not the love and care. It’s a sad story we’ll probably never know in its entirety. If it has a silver lining, it’s that her long-lost cousin has a lovely surprise coming to him.
Seeing things like that on a weekly basis changes a person. There are far too many jobs that make me think, This is not what I signed up for. Things that make me despair of society. I’ve been out to a homeless person who died in a public toilet. That cubicle was his final home and his deathbed. How are we allowing that to happen? Some argue that it’s a lifestyle choice, but I find that hard to accept. I’ve attended people who have been beaten sense-less because they support a certain football team. Why would anyone do that? Grown men, fighting over a game. Stop the world, I want to get off.
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Saturday night, and we get a call to a female intoxicated on the street. It sounds routine, as it almost always does. When we arrive on the scene, the woman is laid on the pavement and has wet herself. She’s just down the road from the pub, so it’s fairly safe to say she’s had a few too many and collapsed on her way home. It’s unorthodox to take people home these days because it carries risks. If, for example, they choke on their own vomit, we’re in trouble. But once we manage to coax her address out of her – which is no mean feat in itself – we make the decision to run this woman back to her house and see if anyone is in.
We pull up outside, I jump out of the ambulance and my partner stays with her in the back. The house is in an affluent area and massive. The front door is slightly ajar and I can hear kids crying inside. I call out, ‘Hello? Is anybody at home?’ No answer. I’m a bit freaked out, so I run back to the ambulance and tell my partner what’s going on. ‘Are the kids all right?’ she asks. Shit, the kids. I enter the house, while thinking someone is going to jump out on me with a baseball bat. Or a knife. I creep upstairs and find one kid, who must be about three, in bed. In another bed is a kid of about six months old, crying its eyes out and with a dog laid next to it, snoring contentedly.
I rush back to my partner, we lug the drunk lady inside, sling her on the sofa and phone for police assistance. While we wait for them to turn up, the baby just won’t settle, so I make it a bottle and feed it. Thankfully, its nappy doesn’t need changing, although with three kids of my own, I’m well used to it. About ten minutes later, this guy strolls in with a Chinese takeaway, bold as brass.
‘What’s going on here? Why are you in my house?’
‘There’s nobody at home with your kids, mate. And we’ve just found your missus, drunk, lying in the street. Where have you been?’
‘On a night out.’
‘Who was supposed to be looking after the kids?’
‘She was.’
Who leaves kids on their own and goes out and gets legless? But this guy has no shame at all. The police arrive as I’m winding the baby. They take some details, arrest the dad and take him away. The police find a number for the woman’s mum and when she turns up, she’s devastated. She’s a lovely lady, and quite well-to-do. She takes her grandchildren home with her and leaves her daughter with us. When she finally regains consciousness, she’s arrested as well: ‘Surprise!’
Back in the ambulance, I feel strangely conflicted. It’s obviously wrong what they did, but who was to blame? Did the man go out for a few beers and genuinely think his partner was at home looking after their kids? Or was it the other way around? Either way, clearly something is seriously wrong in that household. I can’t help but think, What happens next? What will become of these people? At times like that I think, This job is far deeper than I expected it to be. Then another job comes on the screen and I get my head down and plough straight on.
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It’s not always the most dramatic jobs that stick in the memory. I once went out to a fella in his eighties who had taken an overdose before having second thoughts. He had a big house with a nice car parked out the front and was obviously a very successful man. But his wife had recently died and he couldn’t stand the loneliness. On the way to hospital, he said to me, ‘I don’t know why I’m here. I’ve got no kids, no friends and I don’t want to do this any more.’
What I usually say to someone in that situation is, ‘Suicide is a permanent solution to a short-term problem.’ But this case was a little bit different, because of his age. I explained that there were support groups out there, as well as societies and clubs where he could meet new people. I told him that it could be the first day of the rest of his life. It might sound trite, but what else could I do except try to give an old man hope in his hour of need?
I see so many people who are not really living but just clinging on by their fingertips, with no one to take their arm and lift them back up. I’ve seen couples in their nine-ties, with no family or friends, struggling to care for each other without any outside support. I’ve seen unwashed kids wearing no clothes running around dilapidated houses with ashtrays piled almost as high as the dishes in the kitchen sink.
Sometimes I think, Who am I to judge? The lines are often blurred between lifestyle choices and neglect. But sometimes I feel I have no choice but to refer patients to the relevant authorities. Even that process can prove frustrating, because after we’ve filled in the forms, we rarely hear anything back. Not only do we not know if we did the right thing, we don’t know if it was even investigated. All we can do is cross our fingers.
Ambulance workers don’t have time to get too philosophical about the things they see. But we do become very cynical. At least I have. I used to think I was a good Christian. I still hope there is something after death and I sent my children to a Christian school because I like the values the religion teaches. But the more you do my job, the less inclined you are to believe in a higher being. What kind of God would allow a child to die an agonising death from bone cancer? Or of neglect?
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I have had the odd God conversation in the ambulance station, and you’ll find that most people err on the side of science. Doctors and specialists can’t work miracles in the biblical sense, but they work medical miracles every second of every day. I’ve never seen Jesus, but I have seen a percutaneous coronary intervention, which is essentially heart surgery done through a vein. No more being laid up for a month, you’re out in a couple of days and back in the gym a few weeks later.
So until Jesus shows his face, I’ll continue to believe in the evolved genius of humankind. And if I die, turn up at the pearly gates and they don’t admit me, I’ll get the police to knock them in.