“Sally, you just need to hold up your feet and we can roll you to the ambulance.”

“Give…me…a minute.”

60 - I’ve only ever seen one person before with life-threatening asthma. It’s a hellish condition, terrifying for the patient and only slightly less so for the ambulance crew.

55 - Sally’s a very big woman, very big indeed. Morbid obesity is dangerous, hence the moniker, but in the emergency situation it’s not the ischaemic heart disease that causes the problems, nor the diabetes, cellulitis or dyspnoea.
It’s just the weight. If we can’t lift you when you can’t walk, you’re not going anywhere.

50 - She’s bumped herself down the tenement stairs with our help, two of us balancing and supporting on each side, we’ve poured drugs into her, salbutamol, oxygen and ipratropium bromide. The latter is new to the Service and most of us have been thrilled by its effects on the severely asthmatic. It’s barely touched her distress tonight and its impotence has us rattled, we’ve used our strongest magic and waved our most precious talismans at her sickness.
And the sickness is winning.

45 - She’s on our chair now, her hips hanging over either side, her feet drumming on the floor, she lacks the energy to hold them on the foot bar. Normally we’d tip her backwards and roll her on the rear two wheels, pivoting her weight on one point, but she’s too heavy for that. Her breathing is increasingly shallow.

40 - I manage to get her to hang on to the handrail along the path, walking her feet along the path as we push her forwards, but her grip is lessening, becoming less distinct and it flops to her hip. We give her a few moments to recover herself and I speak into her ear, gentle, but insistent, just hold the fence, Sally, that’s all you have to do, just hang on and we’ll move you along.

35 - Sally’s Mum is at the back of us, she pushes her hands through and forces an inhaler into my chest.

“She needs her blue puffer…give her that, she’ll feel better after that.”

Sally’s a long way away from needing her blue puffer, the drugs we’ve given her trump her existing medication four-fold, but the puffer is a security blanket for her and her family. As long as you’ve got your puffer, you’ll be alright. I hand it back to the old lady who continues to fuss and flap behind us, her hands and words as futile as moth’s wings against glass.

30 - Sally’s hand motions are suddenly, subtly different. No longer lolloping and languourous, they move with a sharp purpose, grabbing my shirt and arms. I thrill for a moment, thinking she’s rallied briefly, but then see her movements for what they are, the rambling and fussy motions of an oxygen starved brain.

25 - “She’s hypoxic as fuck…” someone mutters, it might be me, I forget. Myself and a similarly large colleague share the handle at the back of the carry chair and force it downwards, tilting her back and rolling her along the path, our colleagues balancing her either side. Her head rocks backwards and stares up at me as we bump her along the cracked paving stones and down the steps to the trolley.

20 - There are no manual handling classes that prepare you for this, the woman can’t stand, nor can we bodily lift her, but we try. Ultimately we roll her sideways from the chair onto the trolley, forcing our shoulders and biceps against her limp, amorphous mass. My hands slip and slither on her clothes, sweat and piss covering her skin, the smell is significant, but there’s no time to wrinkle our faces or breathe fresh air. We move a limb at a time, great trunks of legs lifted onto the trolley, four of us pushing her down the kerb, not caring about the bump. We couldn’t lower her gently if we tried. The winch screams and wails as we pull her up the ramp into the vehicle, someone bags her lungs, pushing oxygen into her purple, swollen face.

15 - A hand passes me shock pads and I rip the front of her shirt open, sticking the plastic rectangles onto her shoulder and flank.

Flatline.

“Pulse check.”

The technician with the bag digs his fingers into rolls of fat and flesh at the woman’s throat, she’s too large to get close to an artery to feel a pulse. Someone else fumbles for a femoral pulse. I plop the head of my steth onto her sternum and listen intently.

“Absent heart sounds, beginning compressions.”

10 - The paramedics can’t find veins to cannulate, but they do their best, unclipping the trolley from it’s housing on the floor to gain access to both arms, feet, necks. She’s just too padded to get any access.

05 - A short, fat neck is apparently one of the most difficult to intubate and the laryngoscope can’t even get close to her cords. In desperation the paramedic slides the blade into her mouth and over her tongue before connecting the handle and shaking his head.

“We’re pissing in the wind. Let’s run.”

00 - Blue lights and sirens in the distance, I speak to the family, explaining that she’s ‘extremely unwell’ and to be careful driving to hospital. They rage and swear, but pull away after the departing vehicle that carries their sister, mother and daughter - a woman who’ll be declared dead in short order on arriving at the ED.