Nee Naw

Apparently we are getting a spell checker added to the call taking system. This is not a moment too soon. I sometimes think the ambulance service has a deliberate policy of employing people who cannot spell “vomiting” (it’s either vommiting or vomitting. Occasionally vommitting…) or diarrhoea (the permutations are endless…) I know diarrhoea is a difficult word to spell and some people are dyslexic or whatever, but honestly, if you need to write a word several times a day, you should learn to spell it! It’s a shame that a spellchecker won’t pick up the countless calls to persons “laying” in the road (to which my response is always “Laying what? An egg?”).

I’m not sure the spellchecker would help with the following error, though. We had a call to a house called “High Gables” the other night. The call taker spelt it “High Gay Balls”. We may have laughed at this longer than was strictly necessary…

Four people were stabbed to death on my sector (the North East) yesterday.

I’ve been on nights this week, so I was only really involved in the Walthamstow and Tottenham stabbings, though I caught the aftermath of the Leyton one. As they’ve all been reported in the national news, I can’t give any details other than to say what I heard from the crews and 999 callers was quite stomach churning and heartrending, and why the hell do people go round doing this to each other?

What the newspapers DON’T report is the hundreds of non-fatal stabbings that happen every day. Stabbing used to be a major big deal, but now it’s commonplace, and only makes the news if someone died. There was another stabbing in the afternoon on my sector, where the patient had life-threatening head wounds, but I cannot even find one mention of it on the news. The sad thing is that it’s only going to get worse, and I wouldn’t be at all surprised if in ten years’ time, shootings were just as commonplace as stabbings are now.

A while ago, I wrote about Jimmy, a regular caller of whom I am rather fond. (A stark contrast to most of our regulars, who are complete pains in the posterior). Shortly after I made that post, Jimmy called us feeling suicidal and was taken in to the local hospital - something which has happened on countless occasions before. From that day on, we heard nothing. Jimmy went from calling us several times a night to never calling us at all. I remembered what Jimmy had told me - that he’d been told he wouldn’t live to see his 25th birthday, that he was now 26, and certainly wouldn’t live to see another birthday unless he stopped drinking… despite his best efforts, Jimmy had cut down but not stopped. I assumed the worst, and felt sad for Jimmy. This is one of the perils of being an ambulance dispatcher, when one of your regulars stops calling, you have no way of knowing what happened to them. I hoped he was still in hospital, or had moved out of London, or even had miraculous recovered from his addiction, his depression and the health problems caused by his self harm, and didn’t need us any more, but I knew that the most likely explanation was that Jimmy was dead.

This week we received a call in the dead of the night from a address about two miles from where we last saw Jimmy. It was from a 26 year old male, suicidal, threatening to slit his own throat. The landline he was calling from was registered to a “G Smirnoff”. Jimmy’s surname, different initial. Could this be Jimmy, staying with a relative? How many twenty-six year olds are there in North London with that surname and a penchant for slitting their own throats?

As soon as the call taker hung up, I knew I had to call back to see if it really was Jimmy.

The young man on the other end of the phone was in a terrible state. Hyperventilating, crying, talking gibberish.

“It’s the ambulance service,” I said. “Help is on the way - I just need to take your name. For our records.”

No answer. I wasn’t even sure he was listening to me. “Oh god, oh bloody hell,” he moaned. “It hurts…”

The ambulance and police crew were just pulling up. I tried once more.

“What’s your name?”

“Jimmy… Jimmy Smirnoff…”

And the line went dead.

And I almost got up and punched the air in jubilation that Jimmy wasn’t dead.

Jimmy was later blued in to the local hospital with a deep, self inflicted laceration to the neck. It wasn’t an arterial bleed and it wouldn’t be the first time he has done this, so I was not overly worried or surprised. I’m just glad he is alive, and I wish he could know that.

The call on our screen was from Greater Manchester Ambulance Service, and there was a lot of detail crammed into a short space.

“30yof ? ‘mental breakdown’. Has just had daughter taken away from her. ? suicidal. Sister in Manchester concerned for her safety. Sent text saying ‘goodbye’. Patient’s name Anna, sister’s name Jenny.”

A lot of the time, we get calls like this, turn up, find the patient drowning their sorrows but otherwise okay and make a reassuring call to the concerned relative. Other times, we find the house locked, with no answer at the door, call the police round with their enforcers to break it down… just at the point the ‘patient’ returns from shopping. Such ‘patients’ are rarely impressed.

On this occasion, however, the ambulance crew found the door wide open, and the flat empty. The ambulance crew called me on the radio to ask what they should do next. I called Jenny, the sister, to explain what we’d found.

“She’s gone somewhere to kill herself!” sobbed Jenny.

“Do you have any idea where?” I asked.

“No,” said Jenny. “I don’t know London at all! She’s only been living there two months. She moved there to get away from her partner when they split up and took her seven year old daughter with her. But they said her daughter’s got to stay with her partner. They came and took her today. She’s not coping at all, she’s gone crazy. I seriously think she’s going to do something stupid…”

“Do you have her phone number?” I asked.

“Yes,” sniffed Jenny, “but it’s no good, she won’t answer.”

I took the number anyway. Sometimes people WILL answer when it’s a number they don’t recognise, even when they’re ignoring their family and friends. Even in the depths of suicidalness, curiosity wins over. Sure enough, the phone was picked up on the second ring.

“Hellooo?” said a wild, tearful and somewhat drunk sounding voice.

“Is that Anna?” I said. “This is the ambulance service. We’ve had a call from your sister, Jenny. She’s very concerned about you, and she’d like an ambulance to check you over. Can you tell me where you are so we can do that?”

“I don’t WANT an ambulance,” wailed Anna. “I just want to go to sleep! I am nothing but trouble to everyone. I’ll be wasting their time. There are people there who deserve help! Don’t waste your time on me when people are really sick! Tell them to go away!”

We can’t force anyone to have an ambulance if they don’t want to, but there’s no rule against gently trying to persuade them to change their mind, and I certainly thought Anna could do with talking to someone.

“Anna,” I said, “you’re not wasting anyone’s time. We’re here to help people like you. Your sister has called us, we can’t let her down. I’m not allowed to let the ambulance leave until they’ve seen you and made sure you are okay”. (This isn’t strictly true but I was pretty sure she wouldn’t know that.)

“I’m not okay, I’ll never be okay,” said Anna. “I just want to go to sleep. I’m very tired.” Her voice was slurred and distant.

“Have you taken something?” I asked, a feeling of dread rising.

“Tramadol, zopiclone… I took them all… I just want to go to sleep…” she muttered.

Oh, great. I’ve spent enough time on the phone to Guy’s Poisons investigating overdoses for crews to know that this was a potentially fatal overdose. We needed to find Anna.

“Where are you?” I asked. “We need to find you. Please tell me where you are.”

“It’s a nice place to go to sleep,” rambled Anna, seemingly missing the point of my question. “There’s grass, and a weeping willow. I like weeping willows.”

All the while this was going on, I still had the radio in my ear, with an increasing queue of impatient ambulances calling up wanting to speak to me. We usually have a dispatcher to do long winded tasks such as ringing back suicidal people who don’t want to be found, but there’s not enough of that type of work late at night to justify having one, so the radio operator has to do everything. J402 were shouting in my ear every five seconds, “J402, red base, J402! We need to go for fuel! Red base! J402!” and I don’t mind saying that this was rather distracting.

“Where’s this weeping willow?” I asked. “Is it in a park? Are you near your house? The ambulance crew are at your house. Can you go back there?”

“I won’t go back there if they are there,” said Anna, “goddamnit it… I left my travelcard there, now I can’t go back for it… still, it’s okay here, under the weeping willow in the park…”

You see what she was doing? With one breath, she was telling me she didn’t want to be found, with the next, she was giving me clues. She was in a park with a weeping willow, and she’d not had her travelcard with her, so she must be walking distance from home.

Ding-a-ling-a-ling! Suddenly an ambulance pressed its priority button, meaning it had something important to say to me on the radio that could not wait. Hurriedly, I summoned a colleague to answer the radio, then turned my attention back to the phone.

“Anna,” I said, “please let us help you. You’ve taken an overdose which is most likely going to kill you if you don’t get to hospital quickly. You’re not going to go to sleep, you’re going to die and if you die you’ll leave your sister devastated and you’ll never see your child again. Is that what you really want?”

“No! I just want to sleep! I just want the pain to end.”

“We can help you. Just tell us where you are.”

“I told you! Under the weeping willow!”

And with that, the line went dead. I tried to call back, but she wouldn’t answer. Seemingly, she was challenging us. She was giving us enough information to work out where she was, but not making it easy for us. We’d have to show that we really wanted to find her by putting some detective work in. I turned my attention back to the radio.

“NE22. I’ve just spent ten minutes on the line to your patient. She’s taken an overdose of tramadol and zopiclone and she’s in a park, walking distance from her address, sitting under a weeping willow. I don’t suppose you have any idea where that might be?”

“Oh, the weeping willow!” said NE22 sardonically. “Right! I reckon there must be about five hundred weeping willows in Walthamstow. We’ll start looking, but this could take some time. Perhaps you’d better notify the police, over.”

Funnily enough, at that exact moment a new ticket came in from the police:

“Uphill Park, E17. Under weeping willow tree. 30yof ? psychiatric, crying hysterically, talking to self.”

I directed NE22 to the park and crossed my fingers. Just because we knew where she was, it didn’t mean we’d find her. After all, it’s easy to hide in a park in the middle of the night if you don’t want to be found.

Five minutes after NE22 arrived at the park, they had Anna on board and were on the way to hospital. I guess she didn’t try too hard to hide. I guess she did want to be found after all.

I will never understand why some people think it is funny or clever to hoax call the emergency services. Hoax calls cost lives. Whilst ambulance crews drive round in circles trying to find patients that don’t exist and accidents that never happened, and control staff waste hours on the phone trying to determine the location of fictitious incidents, other, genuine patients are put in danger.

The vast majority of hoaxes come from children, most of whom, I hope, get a stern talking to from their parents when the ambulance turns up (children tend not to realise that we can trace any landline call, and the owner of any registered mobile!) and never do it again. There are also a fair few from older teenagers, who, I’m guessing, are doing it for a dare. This type of hoax is pretty easy to spot; the diagnosis is usually blurted out in a rehearsed manner and involves “someone” and a medical diagnosis rather than the more usual description of what has happened. (”Someone’s broken their leg!” as opposed to “My brother fell down the stairs and his leg hurts!”) The caller usually hangs up on further questioning, usually without giving an address. If they do give an address, it’s usually a main road. I can’t ever remember taking a hoax call and not realising it was a hoax at the time, which makes it all the more frustrating because unless we’ve already been to the address that day, we have to treat every single call as if it were genuine.

Somewhat more sinister are the regular hoaxers. We’ve had a few of thesever the years. Some have been prosecuted but some we never find. If a caller uses an unregistered mobile or a payphone to call, it’s pretty much impossible to trace them. There was one young woman who called us every night for months, giving an address near her own every time. When she was eventually traced it was found she was mentally ill and had an obsession with ambulances. Her bedroom wall was covered with pictures of them and she was calling 999 just so she could see one outside. There was also a spate of hoaxes to one address which were believed to be coming from the ex partner of the person who lived there. They always gave outlandish reasons such as “house on fire” “plane crash” and on one occasion, “my wife has cut my testicles off and cooked them in the over”.

This week, we’ve been utterly inundated with calls from possibly the most annoying hoaxer ever. He’s been calling us for a couple of months now, but this week the call rate has gone through the roof. I’d say he is calling a couple of hundred times a day. Each call taker will end up speaking to him around ten times per shift. Of course, we’ve had his mobile cut off, but he just goes out and buys a new one, and he’s back again. He gives his address as 20, [long and well known road], E1. The address he gives doesn’t, strictly speaking, exist - the road covers more than one postal area, and number 20 isn’t in E1. In actual fact, as we discovered the first time we were called out there, number 20 is a Woolworths.

This guy thinks he is *hilarious*. He loves to give his diagnosis as “itchy penis” and I think this is just because he is amused by the word “penis”. Sometimes he will just call up and laugh and say that he needs an ambulance because he or his girlfriend (surely a moron like this cannot possibly have a girlfriend?) cannot stop laughing. Sometimes he will just sing his “address” at us and laugh hysterically. He knows that we cannot hang up on someone if they say they need an ambulance so he will always maintain that he needs an ambulance, despite rarely giving a coherent reason for doing so. Lately, he has given up on giving any medical reasons for needing us whatsoever - instead he will alternately offer the call taker a banana, or request that a banana is brought to him. According to one rather exasperated emergency operator I spoke to, when asked “Emergency, which service? Police, fire or ambulance?” he replied “Greengrocer”.

If I didn’t think it would lose me my job, I would quite happily post Mr Banana’s phone number up on my blog and encourage every single reader to call him, preferably at 3 in the morning, and offer him random items of fruit and veg and see how HE likes it.

Okay, a quick quiz for you. The four jobs that I wrote about on my observation shift with Steve - what do they all have in common. Just a quick recap, there was:
* An old lady on the floor with a broken hip who was in very severe pain.
* A man who’d swallowed a fish bone and thought it might be stuck in his throat, who was alert and standing round chatting when we arrived.
* A rather perplexing depressed man who refused all help from us and sent us away.
* A prisoner with a potentially life threatening arterial bleed after being slashed in the face.

There was just time for one more job before my day out with Steve and his crewmate was over. Glancing at the clock, Steve asked me what I’d like to see. A working suspended, perhaps? A BBA? Anaphylactic shock? No, I said, I’d like to see a bit of nasty trauma.

*RING RING* *RING RING*

I was first in the ambulance and leant over the partition to see what was on the MDT screen.

It was a call to the prison. A prisoner had had his throat slit. This is what happens when I’m not careful what I wish for.

Off we went to the prison, where we were met with by a vacant looking security guard who went through an elaborate ritual of opening and closing gates at snail’s pace before ushering us through and pointing wordlessly in the direction of one of the prison blocks. We were just unloading our equipment from the vehicle when we realised he had disappeared without giving us any indication where he was going. We stood around for a good two minutes wondering what to do next, before a stressed looking nurse came running along and told us we were outside the wrong block. So Steve and I picked up the equipment and ran along with the nurse whilst Steve’s crewmate moved the vehicle. Not a great start.

The prison looked alright from the outside, an unremarkable tall brick building not unlike my primary school. There were gardens and a sports yard, making it even more attractive than Nee Naw Control. Inside the prison was a different matter. Whoever said prisons were like holiday camps never went to this place. It was as cold inside as it was outside (and this was several weeks ago when it was still very cold outside). A horrid smell filled the air, a mixture of hospitals and school dinners. The cold, white walls were unspeakably bleak. We paced along the balcony - one side was lined with cells and I could hear the prisoners shouting or crying or singing to themselves. Some cells had their slats open and through the letter box sized opening you could see the cells were the size of a cupboard and just as bleak as the outside. On the other side, the balcony looked down to the floor below, where a depressed looking cook was serving depressed looking prisoners with slices of pappy white bread and a grey looking slop. Between our floor and the ground floor was a large safety net, presumably to stop prisoners throwing themselves off in despair.

We reached the medical room.

There was blood everywhere. I have never seen so much blood. There were pools of it on the floor, up the wall and even on the ceiling. On the couch sat the patient, wearing what must once have been a white t-shirt and trousers. They were now red. Two nurses were holding a compress to the patient’s face. The patient was fully conscious and clutching a cardboard vomit bowl, which was also full of blood.

“Let’s have a look…” said Steve, and the nurses unwisely pulled the compress way from the patient’s face. It was the nastiest wound I have ever seen in my life. Even Steve and his crewmate looked shocked, and they’ve seen hundreds of nasty traumatic injuries. The gash started on the lower neck and continued to the lower lip. The cut was full thickness and the skin was gaping, revealing bits of fat and muscle and veins and whatever else one has going on inside one’s neck. Blood poured from the wound. Even worse, the cut continued through the patient’s top lip, and I could see it was literally split in two, so when the patient tried to talk the two section dangled separately. Blood was spurting from this wound in pulses, and I understood this meant an arterial bleed. I remembered the occasion when my friend fell out of a jacuzzi and we were all unsure if the bleed was arterial or not - well, now I’ve seen one I’ll know for sure next time! His mouth was filling up with blood and clots which he kept spitting into a bowl. The thing that struck me about the prisoner was that he just looked like an ordinary lad - I guess I’d been expecting some kind of psycho murderer type with big scary eyes and a cold face, but this was just an ordinary person like me. It wasn’t a high security prison, maybe he was just in there for shoplifting or drink driving. He looked terrified and very, very young. The nurse explained that he’d argued with one of the other prisoner’s, who’d gone away and fashioned a weapon out of an ordinary razor by removing the plastic and gone up to our patient and, without warning, slashed him across the face with it.

Steve opened his bag of dressings and bandages and then stood looking at it scratching his head wondering what on earth to use, before settling on some steristrips and some gauze to hold against the wound. Then a member of prison staff came in and told us HEMS was circling overland and obviously expected us to know all about it when in fact we did not even know HEMS had been requested. (Usually HEMS is either requested by the crew or automatically sent as soon as the nature of the call is known, but in this case they’d decided to activate just after we’d left the vehicle). I came in useful at this point because Steve wasn’t allowed to use his mobile to call Control inside the prison and I was the only person who knew the control room’s phone number. So I rang the HEMS desk and gave them the medical report and made sure they were able to land and met by someone more competent than the guy who’d met us…

Minutes later, two doctors and a paramedic wearing bright orange suits barged in.

“Hello HEMS!” I said nervously, pointing to my “dispatcher” epaulettes. “Control staff! Observing! Don’t ask me to do anything! Talk to him!”

“Am I goin’ in an ‘elicopter?” said the patient, his eyes suddenly lighting up, before his mouth refilled with blood and he went back to spitting in his bowl. He sounded about ten.

And then I stood well back as HEMS, Steve and his crewmate all did their best to get the bleeding under control with adrenaline soaked gauze, steristrips, and good old fashioned Firm Steady Pressure. This didn’t stop the bleeding completely, but it definitely slowed down to the point where we could think about transferring the patient to hospital. HEMS decided against taking him in the helicopter to the Royal London; there was a local hospital that specialised in trauma and it would be easier to take him there in the ambulance with HEMS on board. I can tell you it was a bit of a squash in that ambulance: one patient, one prison guard, two doctors, one HEMS paramedic, Steve’s crewmate driving and me in the front. We took the patient in on blue lights but Steve’s crewmate had to be very careful going over the speed bumps to avoid knocking everyone over in the back!

“Mark!” hissed Steve, as we disposed of our patient in A+E. “That’s it. You are never coming out with us again, and you are certainly not going to wish any more calls on us. I’ve had it with you.”

“Did you hear why the other prisoner did that to him?” said Steve’s crewmate.

“No?” I said, thinking it must have been something really nasty. It’s tough in prison. Drugs, gangs, guns.

“Bread!” said Steve’s crewmate. “Apparently they had an argument over the last slice of bread. Other guy goes back to his cell, comes out with the razor, and does that. All over a slice of bread.”

I thought back to the piles of pappy bread on the way in, the revolting smell, the sight of the prisoner’s lip flapping and the exposed flesh in his neck, and all I could do was shake my head.

I somehow seem to have managed to lose a week’s worth of emails to my neenaw address - if you’ve sent me anything recently and not got a reply, please resend it! Thanks.

One of the worst things about this job is having to work at weekends. I’m always acutely aware of the things I could be doing when instead I am rising at 5am to go and sit in a stuffy control room wearing green and talking to idiots, timewasters and the occasionally critically ill person. My general procedure for working Saturdays is to sit with a glum look on my face moaning “The football will be kicking off about now… and now my friends will be in the pub… and now they’ll be out clubbing… and POOR ME”.

And then sometimes, something happens to make you stop feeling sorry for yourself, and that there are much worse places you can be.

An ordinary family, consisting of a man and a woman in their late twenties and their ten month old son, who apparently were not similarly cursed with weekend working, were on a busy single carriageway A-road on the outskirts of our patch. Perhaps they were returning from a picnic in the forest or a day by the beach. Dad was driving and Mum was sitting in the back seat with baby on her lap.

Going the other way on the road was a black taxi.

Who knows what happened to make the family’s car career into the path of the taxi? Perhaps baby grapped at Dad’s hair, causing him to momentarily lose concentration. Perhaps Dad was distracted by the news that Portsmouth had won the FA cup. Maybe he swerved to avoid a squirrel. Whatever it was, it was enough to make the two vehicles meet head on when both were travelling at 70mph. The taxi driver was jerked viciously in his seat, hitting his head against the steering wheel and slumping forward, semi conscious. Mum crunched into the seat in front of her, and felt a crack in her spine followed by the contrast of the numbness in her legs and the agonising pain of her splintered arm. The unsecured baby, meanwhile flew unimpeded into the front of the car, smashing his head against the windscreen, shattering the glass and collapsing in a bloody heap on the bonnet, just in front of his shellshocked father.

Before the FRU paramedic even touched the patients he phoned control for urgent back up. Three ambulances, preferably paramedic crews, and the helicopter, please. Unfortunately, the helicopter was out, so a Delta Alpha was sent instead - that is, an on-call HEMS doctor from their home address in a blue light car. The FRU reported that the baby had a GCS of 3 (ie. was totally unconscious), that he had a head injury and that one pupil was completely blown (indicative of brain damage).

Three ambulances arrived on scene, their blue lights flashing and sirens blaring, and over the next hour, three ambulances left the scene, one by one.

The first ambulance contained the baby. The baby was now in cardiac arrest. The massive head injury he’d suffered had proved too much, and there was nothing anyone could do. Perhaps the only reason he was taken to hospital, rather than being pronounced dead at the scene, was to show the parents that everything that could be done was being done.

The second ambulance contained the taxi driver. With a serious, possibly life threatening head injury, he had little idea of what was going on, which was perhaps a blessing in disguise.

The final ambulance to leave the scene contained Mum and Dad. Of course, they weren’t anyone’s mum and dad any more, but they didn’t know that yet. Mum also had very little idea of what was happening. Collared and boarded, all she knew was that her body didn’t feel right, that pain was everywhere and her baby was not with her.

Seated in the same ambulance, clutching a compress to a dripping wound on his head, watching the paramedics work on his wife, silent, in disbelief, was Dad. He was conscious and alert and not in any real pain. He’d been the lucky one - the only person to escape from the crash without life threatening injuries. Yet his life would be ruined by this family day out just as much as if he had been the one who died.

Edit Since this incident has reached the national news and is now the subject of a criminal investigation, I need to add a bit of a disclaimer. In case it isn’t obvious, this post is a dramatisation of events based on bits of information relayed back to the control room. I was not there and therefore do not and cannot know exactly what happened that day. While all information given is true to the best of my knowledge, please do not accept it as gospel.

The police are still investigating the cause of the crash and the baby’s death.

Our third call was to the local council estate for a middle aged man who was, apparently, feeling depressed and suicidal. Now I like psychiatric patients. Maybe it’s because I’m a bit nuts too, but I seem to have a certain affinity with them and often find myself having long, drawn out chats with them on quiet night shifts.

We rang the intercom and Raymond, our patient, unhurriedly let us in. Silently, he beckoned us into his bedroom, flopped on to the bed and sighed. I wasn’t surprised he was depressed; his bedroom was one of the most depressing places I have ever been in. Walls stained nicotine brown, carpet sticky, furniture ancient, it was severely in need of a make over.

“So, Raymond, what seems to be the problem today?” said Steve cheerily.

“I’m feeling very depressed,” said Raymond in a flat drone. “Worn out and worthless. I shouldn’t be here. I need to be in a home. With people looking after me.”

“Well, I’m afraid we can’t take you to a home,” said Steve. “Do you want to go to A+E? Or have you been an inpatient at a psychiatric hospital before? We can contact them and see if they will take you back?”

“I don’t want to go to A+E,” whined Raymond. “They can’t do anything for me. And you have to sit there for hours. And I’ve been in the psychiatric hospital too. I don’t want to go back there. I tell you, I need to be in a home.”

I couldn’t see any reason why Raymond should need to be in a care home, but it is not the ambulance crew’s job to question this, so Steve suggested to Raymond that he should see someone who could arrange a care home - his GP. Steve’s crewmate rang the GP for an urgent appointment, and Steve told Raymond that we’d run him up to the GP surgery in the ambulance.

“Can you take me back home too?” muttered Raymond.

“Sorry, no - we’ll be sent on another job as soon as we drop you off,” said Steve.

“I don’t think I’ll go, then,” huffed Raymond. “It’s too far to walk. And I can’t afford a taxi.” The GP surgery was actually five minutes’ walk away, and Raymond had no noticeable mobility difficulties.

“Well, what would you like us to do then?” said Steve. “Is there someone we can call for you or something else we can do?”

“I’ve told you,” said Raymond. “I need to be in a home. I don’t know why I bothered calling you. You can’t help me. No one wants to help me. The whole NHS is useless.”

“Raymond,” said Steve, with an admirable show of patience. “I can’t help you get into a care home, because we’re an emergency ambulance crew and we take people to A+E. But I’ve told you how you might be able to get into one, and you don’t seem interested. We can’t help you unless you want to help yourself.”

“No,” said Raymond. “Thank you, but I don’t think I’ll bother. It’s just not going to work out.” And he opened the door and motioned for us to leave.

Since we’d made the appointment with Raymond’s GP, we decided to go anyway, even if our patient was not with us. We piled into the surgery and a very harassed looking GP sat us down, pulled Raymond’s details up on his computer and turned the screen round to face us. I could see that Raymond rang the surgery several times a day, usually demanding to be put in a care home but occasionally wanting other things done for him too. He had a history of not taking his medications and of accusing the doctors of mistreating him in various ways. He would be deliberately misleading about what the other doctors had said to him on previous visits, and because of this he was now only allowed to see one doctor (who I assume drew the short straw).

“Raymond’s been assessed and we don’t believe he needs to be in a home,” said the doctor. “He needs to comply with his care plan and start taking responsibility for his own health. I’ll give him a call when you leave, but it’s nothing he hasn’t heard a thousand times before.”

I found Raymond to be a most perplexing character. On one hand, I know it is the nature of depression that patients feel everything is hopeless and won’t work and that would partly account for why he was so unco-operative. On the other hand, and I know this is a total cliche and supposedly the worst thing you can ever say to a depressed person, but I really did want to say “Pull yourself together! Take some responsibility for yourself! You don’t need looking after, you need to look after yourself. No one else is responsible for the way you feel but you!” I know how the whole argument goes, Raymond can’t help being depressed, it’s an illness, you wouldn’t say that to someone who had cancer, would you? The thing is that while I agree that it is and illness and he can’t help having it in the first place, he can change the way he deals with it. You wouldn’t say “pull yourself together” to someone with cancer because you don’t need to. Anyone I’ve ever known who has had cancer has been determined to fight it. They grasp any opportunity to make themselves better and take any treatment, however painful or expensive. Whereas Raymond just wanted to lie back whilst someone else sorted out his life. Perhaps I should be more sympathetic. Perhaps I couldn’t possibly understand unless I was in his position. But then I thought back to Elaine, the old lady with the broken hip, and how brave she was and how thankful she was for our help, and I didn’t worry about Raymond any more.