You’re not all that fat, but still a tricky airway to manage; I knew you’d give me problems when your head dropped back in that heavy, final way. Your wife didn’t know you’d arrested, but she knew you were very, very sick. I shut the back doors, shaking my head apologeticaly - no, no, you guys drive to the hospital, there’s not a lot of room in here, we’re going to be very busy.

She doesn’t want to watch this. She may think she does. She really doesn’t.

Your face is slick with sweat and makes my hands slip over your cheeks and chin, just a hint of middle aged jowl pulling your face away from the mask, reducing the efficacy of the seal, blowing oxygen around your face rather than into your lungs. When I do push air into you, your chest rises and falls while your stomach rises and remains. I’m breathing for you, but your stomach is filling up rapidly.

You say “Urp.”

A sludgy tide of orange vomit crawls up into your mouth while I’m doing chest compressions; passive regurgitation, we call it. Not vomitting, just opening all the tubes and letting fluids and pressures find their own levels. Your mouth brims with the stuff and as the vehicle bumps over potholes, you slop like an over fill soup bowl in a ferry’s cafeteria. Vomit cascades out of your mouth, up your nose, into your eyes and hair.

I whack the suction up as high as it can go, hoover the goop out of your mouth and nose; momentarily fret about the state of you - live fast, die young…

The bag and mask still won’t push air in. It’s blocked by something, but your mouth is empty, your nose is clear.

Fuck this.

I grab the response bag and pull out a laryngoscope with the longest blade I can find. The last time I did this was on a 64 year old man, with no teeth, having a laparoscopic cholecystectomy. I had two anaesthetists and an ODP watching me.

And the fucking bed and floor weren’t moving at the time.

Push the head into position, slide the blade down the right hand side and sweep the tongue, now lift…don’t lever on the teeth…lift, pull his neck towards the far corner of the room.

There. His larynx. Packed full of spew.

The suction catheter shimmies down along the laryngoscope blade and sooks the last of the gunk from his airway. His vocal cords wave at me, a fleshy “peace out” V shape, with darkness behind them.

You’d be such an easy intubation. I could shove a tube down there right now. It would secure your airway, you could vomit all you like and it wouldn’t matter a docken, I could concentrate on CPR, rather than clearing your throat of acrid lentil soup.

But you’re young. And you’re going to die. I’m realistic about this.

There will be a post-mortem. They’ll ask who intubated.

And the response will come back - “The unregistered paramedic in the ambulance.”

And I’ll be struck off before I’ve even practiced.

Sorry mate. There’ll be folk in my career who I’ll tube who AREN’T going to die. From the history your family gives me, your chances are terrible. I’m confident I know what stopped your heart today; I’ve never seen anyone survive this.

You’re a lost cause.

But I’m not.

Mark’s latest post reminded my of my favourite Essex girl joke. Those of you of an international bent might just have to shrug your shoulders on this one, sorry

There’s a terrible car crash, a Cortina vs a bus shelter, the ambulance crew arrive to find Tracey, a 48 year old woman wearing a boob tube, hot pants and slingbacks with more highlights in her hair than a Blackpool night out. There’s blood everywhere. The paramedic leans in to the cab.

“Hello my love, dont you worry, we’ll get you sorted. What’s your name?”

In a voice like glass in the face of a kitten, she answers

“Tracey.”

“Ok Tracey, just stay calm for me. Can you tell me where you’re bleeding from?”

There’s a moment while she stares at him, then replies

“I’m from bleedin’ Romford, innai?”

-

Makes me laugh…and before you get all nasty, I was born in Essex, so I’m allowed. Nyah.

But lets give it a go.

Let’s say you’re…say, fifty years old and suffer from killer rabbits. You’ve got a long history of killer rabbits, sometimes they’ve put you in hospital.

Your doctor knows about the killer rabbits. He’s given you some rabbit wire to put around your garden, but you don’t really use it very much; it’s a bit of a faff.

Last time you were attacked by a killer rabbit, you needed a fairly sizable operation to fix it. You weren’t well.

So when you call your doctor one morning and say “Hey Doc? I woke up this morning and there was all rabbit poo on my bed and chewed carrots all over the floor and an enormous pot in the kitchen. Also, I found a cookbook called “How to cook humans with carrots” under the sofa. And the other night my wardrobe had this sort of demonic glow coming from inside it, with two demonically glowing fluffy ears poking out of the top and a demonically glowing cotton-tail wagglng out the doors.”

That’s when you don’t want your doctor to say “Mmmm….sounds like a tissue infection. Have some amoxicillin.”

Because when he does that? And I arrive the next day to find that a killer rabbit has ripped the fuck out of your throat and is beating his feet on your dying face?

That’s when the family might want to get in touch with that doctor…

Lawyer, anyone?

I’m writing stories, guys. Just don’t have time to type them up.

Have a photo, instead.

I *did* just buy a wide angle lens and an off-camera flash…why do you ask?

Click for bigness, people.

I’m all swagger and swearing when your address comes up, as we drive round the corner from our standby point, as I pop the same lock I forced last week. What will it be this time? You’re feeling low? Your piles are bleeding? Your gas fire doesn’t work? I rap your door with the butt of my Mag-Lite, shout your name in the landing - come on, open the door, we’re here again.

You let us in, your eyes widened by the knocking. You’re lucid, sober, startled and perhaps a little frightened by our tall shadows in the stair. You barely come up to my chest, I barely come up to BTD’s.

“What’s the problem?”
“My stomach hurts.”

“You want to come to hospital?”

“Yes.”

“Get your shoes on, then.”

We’ve done this dance before, maybe a dozen times. You’ll get to the bottom of the stairs and refuse to travel and we’ll walk you, staggering and slurring, back up to your flat. You tie your laces and I wait for you, address your cat by name, tickle her behind the ears.

You get yourself together faster than I’ve ever seen you do it, tidying a pile of self-help books from the sofa before we leave, a glass of milk on the table instead of your usual cider.

You’re trying to get dry.

In the vehicle you’re polite, cooperative, pleasant. I’m brusque and fast. You give me sad, apologetic little smiles and I hear lilts and shadows of home in your accent. I ask you about your time in Edinburgh, you came here with a man. I don’t ask where he’s gone, but we both agree that people make big changes for folk they love.

Another sad little smile.

You want to know how I know your cat’s name, I explain that I’ve been in your flat at least a dozen times. You’re astonished, amazed. You don’t remember me. You must have been very drunk.

I agree. You were. I’ve never seen you this sober, this bright, this personable.
We laugh about the cat as a mutual friend. I realise you don’t know me like I know you, I’m just another chest of badges and embroidery through an ethanol haze.

You apologise for being so drunk those times, you’re really trying, honestly.

Feeling like a prick and a bully, I drop the attitude. You thank me when I drop you off.

Get some perspective sonny, you might just live long enough to need it.

You were doing three times the limit on black ice, your car hit a tree at a rate that should have killed you.

You’re screaming about your leg, which is (in radiographers terms) fucked.

You ought to be dead; your youth gives you assumptions about your immortality that will one day catch up with you. They’d be charming in a kid. In you, I’m simply irritated.

So please stop whining about your jersey. It’s getting cut off. You are not going to sit up and take it off, I am not explaining to the doctors why you’re paralysed NOW when you weren’t at point of impact.

Yes, I know, it cost you forty quid, you just got it today.

Your choice is agonizing pain with your sweater intact (and we’re just about to haul the broken ends of lyour leg back into alignment) or fuzzy floatiness with a split sleeve.

Get some perspective.

You never know, you might live long enough to need it.

Driving south through the Highlands this week, I was busy regretting not owning a wide angle lens and the ability to shoot landscapes.

So instead, I screwed my “thrifty fifty” onto the camera and, whenever it took my fancy (and was safe to do so, officer) I shot a blind frame through the windows. The exposure was off, the focussing was sometimes on the muddy streaks on the glass.

But I kinda like the slideshow.

Click the little “explodey” icon, bottom right, for full-screen bigness. Really.

By day four we’d come to an agreement - “You can drive as fast as you like, but it’s gotta be smooth. Drive harshly and I’m taking the keys.”

I’d heard the same lines come from my mouth as the old hands had grumbled at me when I started: “Fuckin’ slow DOWN. Get the gears up, watch for the potholes. Jesus! Gas, brake, gas, brake, didn’t they teach you acceleration sense!? THINK about where the vehicle’s going to be, look ahead!”

You listened and learned and drove like a pro. By the second shift you were teasing me about eating plums, shyly slagging my choice of radio stations.

In exchange I taught you to pop a Yale lock with a piece of stiff plastic, your eyes widening as the door swung open. You learned to communicate about a patient while the patient was in the room, we talked at length about what we’d do if this old dude arrested when we sat him up - though fully lucid, he had no clue what we were discussing.

And when things got bad, when that car smashed into the tree and the boy’s neck AND legs needed attention? You plopped down on your knees in the ice and mud and held his head still for the fortyfive minutes it took us to get him sorted.

Prima and Kojak found the two of us in the COI bay, a bucket of soapy water on the floor, a mop in my hand.

“Kal?”
“Prima?”
“How come you’re mopping the motor out while the new cunt watches you?”

I had a moment….yeah…how come that’s happening?

You flushed, we laughed, Prima accused me of going soft.

You got rid of the ambulance at the end of the shift, palmed it off onto a relieving crew so we could go home. I caught you in the corridor, shifting from foot to foot.

“You alright?”
“Yeah.”
“Ok. G’night then.”
“Ummmm?”
“What?”
“Shouldn’t we wait until six?”

Your diligence is to be congratulated, but no, mate. Although your shift runs from six til six, once someone’s taken your motor, you’re no use to anyone. Take the free ten minutes and go home to sleep.

You’ll be alright.

13:30 - Balinuig Motor Grill

One last trip North before my parents move South. A miscommunication over a party had me planning to travel up this weekend anyway, now the shindig’s off, it’s a final family lunch; me,parents, brother, his wife and kids.

I have too many relationships with the town of my adolescence to reconcile. My parents, their house, the town that damn near drove me nuts - insular and cold, trapped between the sea and the end of the road. But quiet, homely, familiar and home to my brother, sister in law, niece and nephew, dear friends and colleagues. I started my caring career up here, looking after CCGDs kids; he gave the after dinner speech at my 18th birthday party. Now I bump into his laddies in Edinburgh, grown and graduating.

Bright sunshine and snow prompts me to slip my new Oakleys on as I enter Fife, a shovel and thermos in the car, prepared for the worst. The snow thickens as I drive, the sun brightens, my polarised lenses give everything a Hollywood colour cast. The sun like white gold, the deciduous trees mulberry and orange, warm as sandstone interrupted by italic swathes of stalwart conifers.

I love this country.

1530 - A9 Northbound,
Like an abusive spouse, the Highlands have turned on me, clouds as soft and smothering as dove’s breasts thunder down the hill sides, dumping fat, thick snow into the tracks of the chemical tanker ahead of me.

My car wags its tail as the tyres struggle on theslove, there’s a weird rolling-road moment where the speedo reads 50, but I’m only moving forward at 30, the wheels stutting against the ice and tarmac. Rounding a bend the Boar of Badenoch is sharply albino, clouds of drifting snow blowing off its back, settling against the sheep in the fields, brown haphazard lines and groups like collapsed stone dykes.

I wonder if I’ll get home?