“Nice easy one to start the morning,” Jem’s dispatcher had said. He was new to the RRV desk and at the end of his night shift, so she couldn’t fault his optimism. “Fifty-eight-year-old male, back pain. Clammy and short of breath, but aren’t they all?”
They generally were, because back pain hurt like the devil, but on this occasion Jem’s swift assessment suggested her patient’s symptoms were being caused by an aneurysm leaking blood into his abdomen. His face was the colour of cold porridge, his blood pressure was in his boots, and his heart was racing. If the aneurysm ruptured, it would kill him within minutes.
She checked her fob watch, one eye on the monitor as it recalculated his blood pressure. She had been given an ETA of ten minutes for the ambulance three and a half minutes ago, and she was starting to sweat through her shirt.
“Easy, Ian,” she said. “I know it hurts, but try to keep still.”
His blood pressure had dipped again. She adjusted the flow of his IV and gave him a further small dose of morphine, trying to keep him comfortable and calm while balancing his pressure on a knife edge: too low and he’d die, too high and he’d die even faster. She unzipped the side of the defib, making the pads easier to grab. She didn’t want to stress him further by sticking them on his chest.
“Will he be all right?” his wife asked. She was still in her nightie, looking pale and scared, and oblivious to her bedhead.
“He needs surgery,” Jem said. His odds of surviving a rupture repair were about one in five, but she kept that to herself. “We’ll tell the hospital that we’re coming in with him, so they’ll be ready. Do you want to get dressed? The ambulance should be here soon.”
“Yes, okay.” The woman grabbed whatever clothing was to hand and disappeared with it into the bathroom, leaving Jem alone with Ian. As soon as he heard the bathroom door click, he pulled his oxygen mask down.
“How serious is this?” His voice was weak and tremulous, but he’d found Jem’s hand and was holding it tightly.
“Pretty serious.” There was no point sugarcoating her answer; she could see from the fear in his expression that he’d worked it out for himself. She took a shaky breath. His prognosis might have been less bleak had anyone else been sent to him.
“Shit.” He grimaced, his free hand clawing at his abdomen. “Don’t tell Margaret. She’ll only panic.”
“I won’t.”
He stared at the ceiling for a long moment. “Should someone call the kids?”
She put his mask back into place. “That might not be a bad idea.”
He nodded, his eyes closing. “Take my phone. It’s in my jacket—Ally and Jake.”
Jem did as he asked, pocketing the mobile as she caught the first wail of a siren. The crew didn’t wait to be let in; she heard their boots on the stairs shortly after the ambulance doors slammed.
“Hey, Bob,” she said, relieved to see familiar faces.
“How do.” Bob immediately stooped to disconnect the monitor. “Did you request the dream team or did you just get lucky?”
She took the ECG leads from him. “I’m always lucky. You know that.”
Dougie had followed him in, toting the track chair she’d advised them to bring. Careful not to jolt Ian, they extricated him as she packed her kit away. She met Dougie at the back of the ambulance and gave him Ian’s phone.
“Will you get someone to call his son and daughter? Someone who’s not his wife, that is.”
“Will do.” Dougie paused at the driver’s door, keys readied. “There’s an AP waiting on station for you. Looks about twelve, stupid moustache?”
“Great.” She slung her bag into the RRV. “Let me know how you get on with Ian, won’t you?”
“Of course.” He started the engine and then wound his window down. “Jem?”
“Yeah?”
He blew her a kiss. “Your hair looks bloody marvellous, flower.”
* * *
Expecting a summons back to station, Jem put her “clear” through and rummaged around for her banana as she waited for the verdict. Breakfast had been a hurried bowl of cereal at five thirty, and the last thing she wanted was a rumbling belly interrupting her debrief. She was chewing her first bite when the radio buzzed.
“Hey, Jem,” Ryan said. “There’s a Darren Baxter waiting at Darnton for you, if you can make your way—actually, scratch that: choking baby coming through.”
“Bloody hell,” she said, off the air. Then, “Anyone else running?”
“Crofton, but they’re eighteen out, and you’re four.”
Cursing the satnav for buggering about, she lobbed her banana onto the passenger seat and turned off the side road, hitting her sirens at the first set of traffic lights. The baby had probably just coughed on a feed, scaring its parents half to death, but Jem of all people couldn’t afford to be complacent, so she put her foot down, dodging early-morning commuters still bleary-eyed and caffeine deprived, and pissing off a bus driver who was disinclined to pull in for her. The RRVs were nippy little beasts, though, and a straight run down the main road allowed her to beat her ETA by forty seconds. The front door of the address was wide open, often an indicator of a bad job, but the wail of a newborn audible above the Teletubbies theme tune suggested the crisis had passed. Occluded airways didn’t allow for shrieking.
“Hello? Ambulance.” She gave a perfunctory knock and walked into the living room, where a toddler wearing only a nappy sat eating Coco Pops on the sofa. The toddler grinned and waved her spoon, splattering the filthy fake leather with chocolate milk.
“Hey, sweetie. Where’s your mum?” Jem said. Beyond a connecting door, the cries had softened to a series of hiccupping sobs. She pushed the door open. “Ambulance. Are you in here?”
“Yeah, hiya.” The young woman at the kitchen table blew a plume of e-cig smoke toward the ceiling and nodded at the baby strapped into a bouncer. “She went all red in the face for a couple of minutes, but I think it were wind.”
Jem slowly set her response bag, her defib, and her advanced life support bag onto the kitchen laminate and unclipped her radio. “Tell the crew not to rush,” she told Ryan. “And if you need them for anything else, use them.” She crouched by the baby. “May I?”
The woman used her e-cig to make a “be my guest” gesture and scratched her belly through her onesie.
Cradling the baby, Jem took her into the living room, away from the smoke. The woman stopped in the doorway, leaning on the jamb.
“What exactly happened?” Jem asked.
“I were feeding her, and when she were done she puked up a bit and coughed and went bright red, but by the time I’d finished phoning the ambulance she were fine.”
There wasn’t much Jem could say to that, so she gave the baby a thorough once-over and cancelled the ambulance when the mum declined a trip to the hospital.
“What’s her name?” Jem asked, starting her paperwork.
The mum slotted the baby into another bouncer two feet away from a widescreen television and sat her own arse in the puddle of milk on the sofa. “It’s Polly.”
“Surname?”
“Jolley. With an e.”
Jem blinked. “Polly Jolley?”
“Yeah.” The mum puffed on her cig again. “Cute, isn’t it?”
“Mm.” Jem felt an instinctive kinship with the poor child as she signed her own stupid name on the form. “Any further problems, call one-one-one for advice, okay?”
“Yep, fine. No worries.” The mum tickled the toddler’s belly and stole a spoonful of soggy cereal. “Is that everything? Only I have to get Holly ready for playgroup.”
Not sure whether to laugh or cry, Jem opted for a diplomatic retreat. She squeezed her kit through the door and paused at the front gate to let a gang of schoolchildren go past. Starting work so early was always a brain bender, with everyone else’s rush hour occurring three hours into her shift, when she was busy plotting her first brew and toilet break.
“Is the AP still waiting for me?” she asked Ryan as she shoved her bags into their cubbyholes.
Ryan did nothing to hide his irritation. “He is, and he’s been pecking my head every ten minutes for the last hour. I’d give you a job if there was anything in the stack besides a nineteen-year-old with a blood blister, and Mary Kirkholt.”
Jem fastened her seat belt, her foot idling on the accelerator. “How many is this for Mary today?”
“Three. She got herself wrapped up in loo paper this morning. Then, ten minutes after a crew had untangled her, she called again to say they’d knocked her moisturiser beyond her reach.”
“The silly sod.” Jem had been to Mary more times than she could count. She knew the key-safe number by heart, how many sugars Mary took in her coffee, and the names of all her cats. Regular callers to 999 were a bit like weeds; when one died, another two sprang up in their place, though Mary was more hygienic and harmless than most. “What’s up with her now?”
“She’s stuck on her commode.”
“You know she won’t be. She’s like a whippet, transferring off that thing.”
Ryan’s sigh was the epitome of long-suffering. “I know that, you know that, the well-meaning but sadly ineffectual Frequent Caller Team know that, but when Mary calls…”
Jem finished the thought for him. “Mary deprives someone else of an ambulance for half an hour.”
“Exactly.”
“Never mind, she has loads of decent biccies.” Mary kept a stash especially for crews, and her mugs were clean enough to have a drink out of. She was lonely and mildly demented, although that didn’t excuse her for being a royal pain in the arse.
“Alpha Six One Three are going to her, if they can heroically limp there with their rattling suspension and wonky side door,” Ryan said.
Jem smothered a laugh. Bob and Dougie were notorious for wrecking buses and would be more than willing to sit with their feet up at Mary’s for an hour. “I’m sure they’ll manage. Am I heading to station, then?”
“Yes, please. Call clear when you’re done.”
Schools traffic and commuters slowed Jem’s progress to walking pace. She whacked the radio on full belt, singing along to the songs she recognised and flicking channels to avoid the ads. For once, the BBC weather forecast was spot on, and the predicted rain began to fall as she finished her banana at a pedestrian crossing. Ignoring the advice of the lollypop lady, the children in the road sprinted for cover, their bags held over their heads as they tussled with each other for pole position.
The downpour persisted, but the traffic petered out the farther Jem got from the town centre, and she pulled into the car park at Darnton before she could be diverted to another emergency. Having entered the station unnoticed, she dabbed her hair dry in front of the loo’s tiny mirror and then ran her fingers through its cropped strands, still inclined to do a double-take when her fringe fell just so without requiring a twenty-minute resuscitation effort and half a ton of clips.
“Right,” she said, not exactly brimming with confidence but not about to hide in the cubicle either. “Let’s get this over with.”
She found Baxter in the office, playing on a phone he quickly shoved into a drawer. He looked even younger by daylight, the over-keen central heating giving his cheeks a rosy apple gleam.
“Morning.” She stayed by the door, anxious to start things off on the right foot. “You wanted to see me?”
He stared at her for a couple of seconds as if trying to place her face, and then hid his discomfiture in a flurry of paper straightening and file opening.
“Yes,” he said, his voice cracking. He cleared his throat and tried again. “Yes, I need to go through a clinical debrief for the Abbey Vale job. There’s been a lot of media interest, and it’s likely to go to Coroner’s, so I want to make sure we’ve crossed all our t’s.”
This was new. Jem was no stranger to Coroner’s Court, but she’d never had any official preparation beside a copy of her Patient Report Form and Kev tagging along for moral support. Baxter was also new to his role, though, so she supposed she couldn’t fault him for being thorough.
“Do you want a brew?” she asked. Once the meeting finished, she was unlikely to hit station again before midday, and there was no way she was raking over the details of that night without a mug of tea in her hand.
“No, thank you.”
Pre-empting any dissent on his part, she went to the kitchen and made her drink, collecting a packet of shortbread from her locker on her way back. He’d covered the desk in case-related paperwork during her absence; she could see copies of her police statement, her Patient Report Form, and the forms Harriet had completed after terminating the resus.
“Talk me through the job, step by step.” He clicked his pen three times to get its recalcitrant nib out and turned to a fresh page in his notepad. “I’ll stop you when I have a question.”
She sipped her tea and pulled her PRF toward her. She had completed it in retrospect, recording her actions in clinical terms and abbreviations—BLS commenced immediately, IV access gained, left external jugular, Airway secured, 7.0 ETT—and she fell back on that same tactic now, distancing herself from the emotions she’d felt, and not mentioning how close the physical strain had come to overwhelming her. Baxter filled his pad with an illegible scrawl as she spoke, and she paused in expectation when he rattled his pen against his thumb. She had just described the moment that Kyle had stopped breathing, and her mouth was so dry she had difficulty swallowing her tea.
“Why didn’t you call for backup?” he asked. “When Parker went into cardiac arrest, why didn’t you request immediate assistance?”
She indicated a line in the middle of her PRF. This wasn’t her first rodeo; she knew how likely these jobs were to come back and bite her on the arse, and she had documented absolutely everything, no matter how trivial.
“I’d informed my dispatcher of Kyle’s deterioration. I think my exact words were, ‘I need help out here. This lad’s about to arrest.’ Once he actually had arrested, I was a little too preoccupied to repeat the request.” Trying to rein in her temper, she gripped her mug until her fingers began to tingle. She was usually far more diplomatic when dealing with management, but Baxter’s question was a ridiculous one, and it had hit a nerve. Later newspaper reports had seized on the lack of an appropriate ambulance response that night, raking the service over the coals for inadequate staffing and sketchy emergency provision, and she wasn’t about to take the fall for NHS budget cuts and the resultant organisational chaos.
“Have you listened to the tape?” she asked. It was the first thing he should have done—all radio exchanges were recorded for posterity—but she wasn’t surprised when he shook his head. “Ask for a copy of it,” she said. “I run alongside this dispatcher for most of my shifts, and he’s on the ball. If he’d had backup to send that night, he would have sent it.”
Baxter’s answering grunt was as opaque as his handwriting, so she considered her point made and moved on to describe her actions and interventions prior to Rosie and Kash arriving on the scene.
“Did you decompress his chest?” he said, interrupting her mid-sentence.
In lieu of an immediate answer, she bit into a piece of shortbread, took her time chewing it, and finished the last of her tea. It stopped her from walking out of the room and returning with Kev and a union representative.
“No, I didn’t,” she said.
He sat up straighter, everything about him more animated as he seized on a potential mistake. “Bilateral needle decompression is indicated in cases of traumatic cardiac arrest.”
Jem clasped her hands in her lap. While she lacked confidence in most social circumstances, she had no such qualms when it came to the technicalities of her profession. “I’m aware of that. In this particular case, however, the patient’s lungs were functioning just fine, and the portion of grey matter I found on the riverbank strongly implied that the arrest was due to cerebral trauma. The last thing he needed was me giving him a double pneumothorax because I’d blindly followed the guidelines.”
“So you decided to go against protocol,” Baxter snapped.
“I used my common sense,” she said quietly. “Have you seen a copy of the post-mortem?”
He folded his arms like a petulant child. “No. Have you?”
She hadn’t, but thanks to Rosie she knew what had been on it. “Kyle Parker died of a diffuse axonal injury secondary to a massive basilar skull fracture. He had multiple minor injuries consistent with an assault, and his tox screen was positive for a whole cocktail of crap. Other than the head injury, his gross anatomy was intact.” She didn’t spell the rest out for him. She just said a silent “thank you” to Rosie and watched his face turn even redder.
“You get a lot of jobs like this, don’t you?” he said, taking hold of a pile of PRFs—her PRFs, she realised—and leafing through them. “You’re averaging about three arrests per shift: suicides jumping off buildings in front of you, chokings, hangings, stabbings, a couple of shootings, cot deaths. You’ve had six partners come off your line in the past eighteen months, citing stress as the reason, and an unusual percentage of calls that turn out to be far more serious than their initial triage code would suggest.”
Unsure where he was going, she didn’t respond. It wasn’t as if she was unaware of the facts he had just reeled off, nor could she deny them.
“Kyle Parker will be your fourth Coroner’s Court appearance this year,” he continued, “and we’re only in the middle of March. Some paramedics never get to go there in the entire course of their careers.”
Something in his tone made her ears prick up. She studied him with more care, noting how tightly he held her paperwork, and the undisguised resentment in his expression. He wasn’t angry with her, he was jealous that she had dealt with jobs he would probably give his eyeteeth to experience. To a certain extent she understood his envy. She had felt the same way when she first started, craving the excitement of major traumas and the critically ill, calls that would put all of her training to good use, but no one wanted to deal with a near-constant deluge of such jobs, and she would be content to see out the remainder of her career working shifts with a regular mate, managing falls and innocuous bellyaches and idiots who should know better.
“I don’t self-allocate,” she said, reminding him that his role as an Advanced Paramedic allowed him to do just that. “I go to the jobs I’m sent to, and I can’t help what they turn out to be.”
He scoffed as if to dispute that, but it was a kneejerk reaction he took no further. “The court will require a statement from you,” he said, drawing a line beneath the discussion but seeming satisfied he’d won some kind of victory.
She collected her mug and biscuits, her patience worn to the point of snapping. “I’ll email it to Legal as soon as they formally request one.”
“I’d like to see a copy before then.”
“Fine.” She stood and opened the door, letting in a blast of diesel fumes that still smelled better than his office. “I’m going to tell control I’m clear.”
She walked out without waiting for permission and sank into a crew room chair between Bob and Dougie, who were sitting with their feet up, watching Homes Under the Hammer.
Dougie muted the television. “You all right, flower?”
“Yeah, thanks.”
Bob looked sceptical but didn’t comment. He collected their mugs and went into the kitchen. Seconds later, she heard water pouring and the creak of the toaster’s lever.
Dougie picked a crumb out of his beard. “We saw Spence at West Penn. He reckons Baxter’s after a transfer to this group.”
“Terrific. We’re already firm friends.” Too stressed to dwell on the possibility, she changed the subject. “How was Mary Kirkholt?”
Bob returned in time to catch the tail end of her question. He arranged brews and toast on a low table and helped himself before answering. “She was fine, very chirpy, and absolutely not stuck on the loo. KitKats and Jammie Dodgers today, and we’re now off the road until someone comes out to fix our side door, so it’s all coming up roses.”
“I should call clear.” Jem unclipped her radio, but Dougie put his hand on hers.
“Have five minutes. If they really need you, they know where you are.”
She relented and picked up her mug, shocked when her hand trembled hard enough to slosh tea over its rim. She hadn’t realised how badly Baxter had unsettled her. “Okay, five minutes.”
Bob passed her the toast. “Good girl. Oh, by the way, we asked our dispatcher to follow up on that bloke from this morning. Ian with the aneurysm.”
She nodded, braced for the worst. “And?”
“Stable and heading to High Dependency, and his children are sitting with his missus.”
Jem dropped her toast onto her plate. “Get out. Really?”
“Yep, really. Apparently, his wife wanted all our names for a thank-you card.” He cackled with his mouth full. “Tell Baxter to put that in his pipe and smoke it.”