The locus is weird, not somewhere you’d find yourself as a pedestrian and the story is so over the top that we’re convinced it’ll be exaggerated by the caller.
But when we arrive, we realise that we’re wrong.
When…I hesitate to use the phrase ‘bad people’…but let’s go for “society’s fringes” find themselves with a disagreement they tend not to go for sensible discussion, the small claims court or the Citizens’ Advice Bureau.
They grab you off the street, take you somewhere far away and do beastly things to you.
And then dump you, brutalised and far from home.
Now, I’ve had my share of people being unpleasant to me, but I like to think that by not subscribing to the class of “I shall further myself by doing beastly things to other people” I’ve managed to avoid this particular shade of retribution.
Which is a nice thing.
Because it looked sore.
He’s a hard man, there’s no doubt of that. He’s so hard, it’d probably be capitalised.
A Hard Man.
But he’s crying, screaming about the pain of his cracked and shattered bones.
I can’t blame him and loop a tourniquet around his bicep.
“You’ll not find a vein on me…” he begins and I tend to take this statement with either a dose of sodium or the arrogance of the challenged, but when BTD starts searching his skin for the shadows and paths that will guide us into his circulation he realises the problem.
“Are you still using?”
“A bit. I’m on methadone. I told you, you’ll not find a vein on me.”
His veins are…gone. There’s nowhere to go, each blood vessel near the skin has been injected time and again until they’re useless. I whip the sock of f the leg that isn’t smashed up and put a tourniquet around his ankle too.
“I think there’s one down there.” he begins “The big one around the ankle bone?”
The three of us relax into an easy banter, bonded by the practice of vein finding, though two thirds of us are, perhaps, more legitimate in our experience!
“Fuck’s sake, pal, you don’t make it easy for us, do you?”
He laughs at me before turning his arm this way and that for BTD – “You’ll maybe find a wee one at the back of my elbow, I couldn’t get to that one.”
The task seems to have distracted him from his pain and he’s relaxing. Good, things are looking up. In fact, things are looking very up, a tiny nematode of a vein is just palpable in the top of his foot. With a blue cannula, the tiniest we carry, I reckon I could just about get in there. I swab it.
“Awww shite, hurry up!” he urges BTD “The big cunt’s gonnae jag my foot, it’s fuckin’ nippy….”
“Sorry pal…” I say, before sliding the needle into the skin and peering at the end for the “flash”, the sudden rush of blood up the needle’s lumen that tells me I’ve punctured a vein.
I slide it back a little, palpate again for the vein and readjust my line of attack, pushing the point of the needle forwards under the skin.
“Ayiee! Big yin! Nerve! Nerve!”
I’m defeated, yet confused. I slide the cannula out of his skin and glare at his foot. There’s the vein, right there, I can *see* it, I can *feel* it, I’m staring at the skin like a seer at entrails when my right hand complains suddenly, in particular, the end of my third finger.
I look down at my hand, tranquil and serene in gloves of duck egg blue, the uniform of the medic at the bedside, the healer, the cool cloth on the brow in your fevered night.
The tranquillity is desecrated at my fingertip, rude and passionate as blushing cheeks a perfect sphere of bright blood is forming on the vinyl. Perfect sphere. Not smeared from anyone, but bubbling up from inside me.
I’ve jagged myself.
I’ve jagged myself with a dirty needle from a IV drug abuser.
I push the needle into a sharps bin next to me (and curse myself for not doing so earlier…stupid, stupid….) and rip the glove from my hand, squeezing the base of the finger in my fist and forcing blood out of the wound. Make it bleed, they say, flush the infection out with your own clean blood.
I make no attempt at cleanliness, I squeeze and push, milking and kneading blood from my finger that spatters onto the floor.
They teach you at college to constantly reassess the danger you’re in, change your tactic if need be. If you’re at risk, return to the start and check everything again.
I’m no longer safe, but don’t want to panic anyone.
“BTD, this isn’t working. Let’s give him some gas and go. By the time we’ve fannied about here we could be at A&E.”
“Just let me….”
“Let’s just gas him…c’mon.”
“I’ll get a set of obs?”
Fuck the obs! Fuck his pain relief! Fuck professionalism and service and duty and what’s right and everything. Fuck everything. I want to go to hospital. I want cool tranquil gloves at my bedside and someone to take this away from me. Someone to wake me up. To tell me I haven’t done what, despite what I wish, I clearly have.
I pull BTD to one side.
“I’ve stuck myself, mate. With his needle.”
His eyes widen.
“Right. Right. Ok. Let’s go.”
But the patient’s overheard.
“I’m clean, pal. You’re safe.”
It’s not an easy conversation to have with anyone, let alone when the person who YOU’RE meant to be calming and treating is now sitting in your seat, ministering to you. But I grab his lifeline and haul on it.
“When did you last get tested?”
“Six months ago.”
“And you’ve used since then?”
“Only clean works, I swear it. Honest neebor, I wouldn’t bullshit you.”
“Sexual partners? You always use a condom?”
His eyes flick to the floor for a moment before he answers.
“I’ve a girlfriend, eh?”
“And there’s no-one else?”
Again his eyes go to my boots.
My soul joins them.
I’m meant to drive to the hospital now. Four and a half tonnes of vehicle with a patient and my mate in the back, the latter not even belted in. I’m talking to myself as I go, a rising cadence and pitch to my inner monologue of “Oh Jesus….Jesus…..” before I slam the window shut between the cab and the back and talk, out loud to myself.
“Get a fucking grip. Keep the head, c’mon. Just drive. That’s all. You can’t make it better right now and you want to go to hospital. Pay attention, look at your mirrors, watch the traffic in front. It’s wet, it’s dark, mind your speed. Don’t turn the blues on, however much you want this to be over faster. Just drive. That’s it. Keep the head. Drive.”
It takes twenty minutes to get to hospital. But it might as well be a week. I radio the control room and let them know what’s happened, that I need an officer to meet me. It’s immediately as I hang up that I realise I don’t need an officer. I need a mate.
So I ring one.
I don’t work with Pally on the road so much anymore, not since he got promoted and drives his desk instead. He’s not on-call, but we’ve seen each other through some hard times before. He agrees to meet me at A&E.
When I open the back door of the ambulance the patient returns to his reassurances to me that, really, I’ll be fine. Nothing to worry about, he’s clean.
“Would you take a test tonight?”
“Sure, no problem…d’you think they’ll test me for chlamydia?”
“Oh Jesus, seriously?”
“I’m just kidding with you, pal.”
Oh? Well two can play at that game…
“Can you transmit chlamydia through blood?”
“Well maybe I should double my chances, take you out the back and shag you too?”
He guffaws and slaps my arm and I do the same to him before booking myself in, holding my mask tight to my face.
Aye. Relax. Okey dokey.
There are advantages to working in the A&E service when you book into the Emergency Department. But disadvantages too, including the fact that everybody knows you and soon finds out what you’re in with.
Margaret the receptionist gives me a sympathetic look.
“Don’t be nice to me, for God’s sake…don’t be nice to me…”
Because, I don’t know about you? But when people are nice to me and I’m just barely holding my shit together?
Being nice to me is lethal.
I handover to a nurse and she points me towards a cubicle. Pally rocks up and immediately takes the piss, which, frankly, is exactly what I need him to do.
Doctor Doug joins me in the cubicle with a med student, I tell him the story and he runs me through his plan. It’s simple, really. They take my blood to store in case anything develops later, they test the patient right now to find out if he has anything nasty and in the meantime, I take a shit-load of anti retro virals to stop my body from allowing any viruses I’ve picked up to grow and develop.
Easy, one two three. The blood is taken and stored, I’m given a Hep B booster, though I’m pretty certain I’m up to date with my inoculations for the same. Doug runs me through the chances of transmission.
“HIV in the IVDU community runs at about 3%. The chances of transmission for a used needle stick incident are approximately 0.1%. With the PEEP medication, we can pull that down by a further 80% of the current risk. Hepatitis B you should be cool for, since you’re covered and he has no history of that either. HepC may be a problem.”
“HepC infection runs at about 33% and the chances of transmission are much, much higher. That’s what we need to be worried about.”
He steps outside to talk to virology about me and on his return I buttonhole him.
“If I *do* have HepC? Which seems to be our biggest risk?”
“What would be the implications there?”
“Well, you’d have some coagulopathy issues, you’d be much more prone to liver cancer, but these are issues that we can deal with surgically or with medication.”
See? No “You’ll be dead in a week.” No “Your liver will come squirting out your bum.” A risk of cancer (shit, I’ve got a risk of cancer anyway, EVERYTHING causes cancer…) but nothing described as insurmountable.
“Professionally, I don’t know how it stands for you guys, but if I was diagnosed with Hep C, I wouldn’t be able to work in A&E. I doubt you’d be allowed to remain front line.”
Because in truth, I can’t really imagine becoming critically, terminally ill, my head won’t let me.
I can imagine losing my job, though. I can see that in my mind.
And it scares me.
He gives me a stack of pills – “They basically cause malabsorption, so on the upside, you’ll lose some weight…” including a variety of remedies for nausea and diarrhoea, wishes me well and tells me that they’ll phone me in the morning with the results of any horrible diseases my patient has.
Pally drives me to the station and I drive myself home.
Bambam has a tea poured for me. I hold it in both fists and stare at my feet before bursting into tears and vomitting out the entire story, everything that frightens me, everything that has me furious with myself.
She has work tomorrow.
I clearly don’t.
I demolish a bottle of vodka to make me sleep.