Paramédico

SHEIK, RATTLE AND ROLL

England

On the rain-drenched morning Henry takes the wheel I am secretly relieved the old man we are carting from one sad nursing home to another is afflicted by a state of dementia so advanced he is seemingly oblivious to our existence and stares silently ahead into a land beyond. Normally I wouldn’t wish the illness on my worst enemy. But as Henry pushes the siren and races down Herne Hill towards Brixton at the speed of a Grand Prix driver on amphetamines, it’s a good thing our patient – someone’s dear grandpa – is numb to it all. The old man bounces around like a leg of ham in a delivery van. In fact, groceries and daily mail probably get better rides than this in London.

Approaching the intersection of Milkwood Road and Half Moon Lane is where we have the fourth near miss of the day. A car appears from nowhere, as Henry puts it afterwards, making it sound like a supernatural phenomenon beyond human comprehension. While hurtling through the red signal without slowing I assume this apparition has approached from the right, but I see nothing at all as I’m riding in the back clutching a crossbar with one hand and the patient’s shoulder with the other. When Henry plants his generous weight on the brakes I’m only half ready for it. Equipment flies into the front cabin, some of it catching me while passing. Airborne oxygen masks and kidney dishes are the least of my concerns. Our old man, drooling and wide-eyed, has long lost the instinct to hold onto the stretcher rails and our extreme deceleration threatens to catapult him through the windscreen. I have little choice but to throw myself on top of the patient, his brittle bones digging into me as I pin him to the mattress with my body. A sound of screeching tyres and angry horns is followed by the choking smoke of burning rubber pumping into the back of the wagon.

‘You all right, geezer?’ Henry asks once he has pulled over past the intersection, his face pale and puffing.

‘Think so,’ I say in a neutral tone, until it occurs to me how pissed-off I really am and I add, ‘Why the urgency anyway, mate? We’re going to a bloody nursing home.’

‘He should ’ave seen me comin’, tha bastard.’

But Henry has only himself to blame and he knows it. Lights and sirens are merely a request for people to give way, not a demand.

Henry’s hands are trembling as he collects the bits and pieces littering the front cabin. Though he seems shaken, I know he will do it again, maybe even today. Like a poker machine that eventually pays out, we’re long overdue for a prang. And if eventually he kills a man, or more than one, I want nothing to do with it.

Got to quit, got to quit, got to quit.

What am I still doing here?

With its prestigious-sounding name no one would suspect a shoddy operation from this private Harley Street ambulance service. Ambulances plush as limousines, I thought. Only these would satisfy the British high society and foreign millionaires who visit the nation’s famous strip of specialist rooms and luxury clinics.

Perhaps the greatest insult one can give a genuine paramedic is to call him or her an ambulance driver, yet this is what I was, my paramedic degree as useful as a sheet of toilet paper. The art of driving grannies to doctors’ appointments had, as I recall, never been covered. Why my skills were unattractive to the London Ambulance Service (LAS) when I applied for recognition of prior learning, I just don’t know. The LAS was naturally my first choice, but the process facing foreign paramedics hoping to get on London’s ambulances is known to be so long and painful that most don’t bother. Ironically, ambulance services in sunnier countries of the world like Australia and New Zealand have made quite a business of poaching British paramedics and have done this so aggressively over the past decade it has created a shortage of paramedics in England, and a minor political storm.

Wasted skills aside, better money can be made working for private patient transport services anyway, even if it represents a significant drop in action. Nor is it wise to remain jobless while waiting for the bureaucratic process of the National Health Service. As Iraqi doctors and Iranian surgeons flipping burgers in London’s takeaway joints can attest, survival rules over pride in this cruellest of cities. Yes, we’d all like to work in our chosen careers, but decent heating and square meals are the only way to get through winter, and Kass, my then girlfriend now wife, needs a new woollen coat. Still, I wish we had chosen Barcelona over London when deciding on a city in which to base ourselves for a few years of European exploration.

It’s colder than deep-sea diving off Alaska. Even with the windows up and my green fleece zipped tight I feel like an ice sculpture. We drop the patient off at his five-star nursing home – quite literally ‘drop’ as Henry claims he ‘wasn’t ready’ with the head end of the stretcher at the moment I called ‘one, two, three’. I’ve come to expect this kind of thing when Henry is way past his fried chicken and chips time. It will be his third lot in a single morning. Another of his shirt buttons is sure to pop before the day’s end.

We park at a Harley Street corner so we can make a rapid response to the next boring transfer. As the rain thunders on the window, I watch Henry munching fried chicken, getting it tangled in his scraggly ginger beard and dropping it down the front of his uniform. In fact, his uniform is already stained from previous fried chickens. With a belly like that there’s only one place falling chicken tends to land.

‘So, you is telling me you once got a hundred quid tip off a Arab?’ he says as he eats, displaying the contents of his mouth.

‘Yeah, Kuwaiti royal family.’

‘Kuwai-i royal family?’ he licks his lips, looks annoyed. ‘I neva got nufink offa tha Kuwai-i royal family. Took one of ’em in too, I did. Had a hip done, he did. But tha Kuwai-i royal family never looked arfta Henry, did vey.’

I sigh and glance at my watch, wondering what the Kuwaiti royal family would have thought about an ambulance stinking of fried chicken, driven by a maniac.

‘Mate, you know we got a Arab later on,’ says Henry, ‘four-firtey in from Heafrow …’

‘An Arab, Henry, it’s an Arab.’

‘Yeah, dats wot I said, a Arab.’

Worst thing about having an ambulance with a broken stereo is that it forces one to listen to a partner chewing fried chicken and using bad English in England.

‘Well,’ I reply, ‘it’s nearly two o’clock, and you know the traffic.’

Henry knows the traffic all right. This is part of the problem. He loves nothing more than to plan his day so that unless we use our lights and sirens we’ll be late to every appointment and pick-up. This is because, quite frankly, he loves to use the lights and sirens. When I first met Henry I spotted him right away as a wannabe paramedic who never made the grade. Being an ambulance driver is a little boy’s fantasy as much as being a train driver or bus driver. In most emergency medical systems, however, ambulance drivers must also use clinical skills normally reserved for doctors. This naturally excludes a good number of candidates, Henry included. Society is full of disappointed men and women who have longed to drive ambulances from the age of five when they spent each day constructing matchbox car crashes and sending matchbox ambulances to the scene. Recruitment departments of public emergency services are perpetually inundated by such applicants and spend half their time palming them off.

The only other qualified paramedic working at the company was fired from the London Ambulance Service for visiting a Kensington barbershop while on duty. When I heard this I told him it sounded like unfair dismissal. Medics are normally permitted to visit coffee houses and corner stores in their catchments so long as they can quickly respond. Why not a barbershop? I mean, how long does it take to throw off an apron, brush down a uniform and go out with half a cut? Not long at all. If anything, the gentleman’s commitment to looking sharp and tidy in the workplace should have been commended. As much as I’d prefer it I’m never assigned to work with him. Our boss wants one qualified medic per wagon. And apart from the two of us, the rest are a bunch of fantasists who recently discovered a community college somewhere outside London conducting a five-day first-aid course they believe allows them to use the title ‘paramedic’. Never mind it took me four years of study to earn the same. While I don’t bother wearing anything at all to identify myself as one, these men could not be more decorated. From emergency service catalogues they have mail-ordered paramedic insignia of every description. Cloth patches, embroidered epaulettes, shiny badges, clip-on pins, reflective vests and so on, all emblazoned with the word ‘paramedic’; one ambulance driver is so covered in pins and badges he looks like a walking Christmas tree.

Then there is the gear. While I have trouble locating my stethoscope most days, these men have got every imaginable utility dangling from their belts. There are Leatherman knives, wallets for gloves and scissors, phone holders, torches of various sizes, rolls of Leucoplast, radio holsters, mini disinfectant dispensers, rubber tourniquets and various other oddly-shaped black pouches containing everything but handcuffs. All these are attached for the prime purpose of looking as much like a paramedic as possible, or at least how they imagine a paramedic must look. This I find most entertaining and wonder how I’ve managed to do the same job for so long with nothing on my belt but a buckle.

While some veteran medics would be irritated by such things, I am way more frustrated by the widespread and reckless use of emergency warning devices.

Prince Abdullah al-Sabah’s private jet is to land at Heathrow in twenty minutes and, as I remember from my last conversation with an al-Sabah, they are not fond of tardiness. The Sabahs are thought to hold the largest number of shares in almost all blue-chip companies in the Western world and to have a combined family wealth of US$200 billion. On first meeting the Kuwaitis, my politeness to a veiled female family member was generously rewarded with a crisp fifty pound note pulled from a wad of cash thick as a brick and dispensed by a keffiyeh-wearing aide. Accepting money from patients beyond the agreed payment for services is considered unethical in the medical profession and strictly forbidden for government ambulance workers and hospital staff. But in London’s private health care, tipping seems somehow acceptable and is not uncommon.

‘White car on the left!’ I warn Henry as he comes dangerously close to clipping a sedan that has failed to pull over far enough.

My head is throbbing with the beat of the siren. The Ford Transit parts traffic out of the city like Moses did the Red Sea. It’s slow going, but we’re getting through faster than anyone else.

What is the public thinking, I wonder, those distressed commuters struggling to edge out of our way, imagining the worst? What if they knew that Henry was using his lights and sirens because he thinks it’s fun, because he intentionally ate his fried chicken slow enough for the traffic to build up? And what if they knew I was letting him do it because I’d hate to be late for the Kuwaiti royal family, because I’m hoping for another tip, more than last time – if I’m lucky.

Back in Sydney severe consequences result from the inappropriate use of lights and sirens. Not that we’d bother, anyway. We’re so busy most of the time it’s a relief when the siren is off, allowing us a little peace and quiet. Warning devices are only a novelty for those who don’t use them much.

‘Ow of tha way! Comin’ fru! Move it! Move it! Move it!’ shouts Henry.

‘They can’t hear you,’ I say, wishing he’d shut up.

‘All right, but vey can see me, can’t vey.’

‘See you what?’

‘See me yellin’. Yellin’ and gesticalatin’!’

I don’t know how many private ambulance services there are in London, but ever since routine patient transport was outsourced, every little boy rejected from the LAS could finally drive an ambulance as fast as they like with ‘blues and twos’ – blue flashing lights and a two-tone siren. It was absurd and out of control. By my second day at this company I’d survived three near-death experiences and one flying patient. But when I raised the matter with the boss – a middle-aged, chain-smoking, sarcastic woman with the face of an East London gangster – she looked me square in the eye and croaked, ‘You know by now what the traffic in London is like, son, don’t you?’

And I replied, ‘Yes, but it’s dangerous going fast without a pressing reason.’

And she said, ‘Harley Street patients are special, you understand. They expect the best. They have never waited for anything in their lives. They don’t expect to lie in ambulances while our drivers inch along in traffic, do they now?’

But a day later she inadvertently revealed her true reason for ignoring the fun crews were having with lights and sirens when Henry called up and told her we were unlikely to complete two jobs in the designated time frame.

‘Well,’ she said via the crackly radio, ‘what have you got those pretty lights on your wagon for, Henry?’

Turnover. It is all about turnover and profit. The faster we do a job, the quicker we’re on to the next. We make deliveries like any courier company, but because we deliver human cargo we can make our deliveries in half the time by halting on-coming traffic and momentarily paralysing city intersections.

Henry brakes heavily. ‘Wanka!’ he shouts.‘Got evry fink on, idiot!’

And with everything on we skid into Heathrow making such a racket that for a second airport security must think some hijacking has taken place without their knowledge.

But no, all this Arab wants is a quality heart bypass.

We meet the patient sunk into a deep leather recliner in the lavish corporate jet building, a man in his sixties wearing a stiff white dishdasha and rockstar sunglasses. He’s very pleased when I greet him with the traditional Assalam Aleikum but looks with a little disgust at Henry who struggles to negotiate a leather ottoman with the stretcher.

‘How was your flight?’ I ask the sheik.

‘Bekhair,’ he says, and his aide appears, a different one from last time, and translates.

‘Fine, he says flight is fine, thank you,’ says the aide.

Henry is by my side now. I can smell him.

‘Good to go ven?’ he asks, looking at the aide expectantly. But no wad of cash appears and we stand in awkward silence, a silence like the one after hotel porters take your bags up and you don’t have any change to tip them with. Why Henry expects the sheik will slip him some cash before he’s been driven anywhere is beyond me.

After half a minute, Henry readies the stretcher and we help the sheik climb on.

It’s a rough ride back to Harley Street. I’ve strapped the sheik down well but notice the skin over his knuckles blanche while gripping the stretcher rails. The sheik says something loudly to his aide, raising his voice over Henry’s siren. I fear that any chance of getting a tip now is out of the question. But I’m wrong. Instead of lodging his complaint about the journey, the sheik’s aide leans over and thrusts a fifty pound note into my palm.

‘No, no, I’m not supposed to take this,’ I protest.

But Henry’s siren is so loud I can’t really hear myself and when I try to hand the money back the sheik’s aide takes it and forcefully stuffs it into my top pocket. There is a certain desperation in the way he has given me the tip that makes me think for a moment I’m being bribed to take the wheel and slow things down. When Henry veers sharply to avoid something and leans on the horn for thirty seconds, cursing grotesquely, I consider it. In Kuwait, my partner would be promptly executed for driving like this with an al-Sabah on board. ‘Allah, Allah, Allah!’ cries the sheik.

Really got to quit, I think. The fifty pounds in my top pocket will hardly tide me over until the next job. But I don’t care.

After dropping off the sheik at a cardiologist, Henry curses the Kuwaiti royal family for not helping us out and how the House of Saud is far more generous.

I shrug, choosing not to mention my tip.

‘Henry,’ I say politely as we reach the Baker Street tube station, ‘you don’t mind dropping me off here, do you?’

‘Right ’ere?’ he asks, raising his eyebrows.

‘Yes please. And do me another favour, will you?’

‘What’s tha’?’

‘Tell the boss I’ve resigned.’

ALL QUIET! NEWS BULLETIN!

The Philippines

Lumbering like the giant propellers of an ocean liner, the fan blades turn too slowly and too high above us to cool the night. But the loose chugging and whooshing is sending me to sleep. Behind a heavy wooden desk illuminated by a strip of neon screwed into one of the peppermint-green walls is the chief of the Philippine General Hospital’s Emergency Medical Service, Manolo Pe-Yan, a plump man, unusually serious for a Filipino. Seriousness, however, does not always translate to professional appearance and Manolo is wearing the same singlet he’s been wearing for a week, stained by a dark bib of sweat, his head tipping forward then up again as he sleeps.

It’s 1 am on a Saturday morning. Two white uniform shirts are hanging on the posts of a single steel bed beside me. Snoring soundly upon it, curled up together despite the heat, is a crew of emergency medical technicians (EMTs) seemingly content with the status quo – a parked ambulance and no calls on a night when all manner of accidents and murders are occurring in the action-packed metropolis. A stone’s throw from where these medics are sleeping there is a constant stream of jeepneys, taxis and tricycles screeching to a halt outside the hospital emergency department. Onto the doorstep their contents are dumped: an assortment of stabbed and mauled victims; unconscious men with occluded airways, bodies made limp by the fractures of long falls and pedestrians with broken necks. Last week I worked a few shifts in the emergency department and dragged these people in, seeing how nasty and critical injuries and medical cases become without pre-hospital care. And while I did this, across an island of lawn and flowerbeds, under a low tin awning, two beautiful late-model Chevrolet ambulances stood washed and polished – and silent.

‘Okay, tayo marinig ng ibang song!’ Another Filipino hit is announced on a little transistor radio. It’s all we listen to. A World War II ceiling fan and cheesy music, neither of which is ever switched off – the ceiling fan for obvious reasons and the radio because, in its truest definition relating to ambulance work, we are listening out for jobs. There is still no central emergency number in The Philippines, no control room or ambulance dispatch. So we wait, as we do most days and nights, monitoring the half-hour news bulletins on ordinary FM radio and the occasional updates between Pinoy rock classics by Sugar Hiccup and Tropical Depression. Occasionally, maybe once a week, a member of the public will arrive breathless at the ambulance station, pointing in the general direction of some traffic collision nearby. But mostly we wait for a radio announcement – sometimes for weeks on end – about a pile-up on one of the many highways and skyways crossing Manila. Last month, both ambulance crews took it upon themselves to respond to a train derailment after hearing a report on the radio, but have since done little else.

The air is thick with humidity and the smell of green mangoes. I look around the room and see I’m the last one awake. Having no comprehension of Tagalog, the 1 am news means nothing to me. Half of Manila may have gone up in flames and I wouldn’t know. Nor would my colleagues stir from their slumber. There is nothing to do but stretch out on a bench near the door and submit to the urge to close my eyes.

In heat like this my dreams are always bizarre. The emperor of a mighty country, suddenly inspired into a random act of generosity, orders all hungry tramps in the land to be issued a jar of his finest caviar. But one of the tramps is unhappy and says, ‘Just give me a damn sandwich!’ The tramp says this about the same time I wake up and turn over. While I drift off to sleep again I comprehend the dream may well have been about our two ambulances donated by the United States government. They came with the latest, high-tech equipment, with pulse oximetry, twelve-lead ECG machines and pneumatic ventilators. Like caviar to a tramp are these ambulances to The Philippines’ largest public hospital. Only yesterday we took a patient in from another facility hooked up to our automatic ventilator and found there were no ventilators in the intensive care unit of the hospital. How odd it was to see our state-of-the-art device replaced by a simple bag-valve-mask – a bag manually squeezed every four seconds or so by the patient’s beloved without interruption, sometimes for months. No wonder the bag-valve-mask is known here as as a ‘relative ventilator’. And because the chain of health care is only as strong as its weakest link, there was considerable discussion among the EMTs about why they bothered connecting the ventilator in the first place. More interesting to me was to volunteer in a country where ambulances are better equipped than the hospitals they deliver to. It’s May 1998 and I’m only here for six weeks – half my time ambulance-riding, half island-hopping – far too short a period to help create awareness of a paramedical service among twenty million people in the most densely populated city in the world.

Manolo nudges me with a Philippine breakfast plate of champorado – a combination of sticky chocolate rice served with salty fish, a fish which I detest and usually discreetly dispose of so as not to offend my hosts.

‘We have very important meeting in the evening, Joe,’ grunts Manolo, using the rather annoying nickname I share with every other Western male who bears the slightest resemblance to an American GI. Manolo’s face doesn’t give anything away, even when I know he’s being funny. I’m certain it’s his own type of humour, that he’s one of those straight-faced funny men.

I raise my eyebrows and take the bowl.

‘Chinese Fire Brigade again?’ I ask.

‘You’ll see, Joe,’ he answers.

The two EMTs, Juan and Fermin, are awake. Fermin is brushing his teeth in a sink by the door while Juan runs a comb through his hair over and over again, staring ahead with a drowsy gaze. Neither of them bothers getting into their uniform shirts. They only do this if a job comes in or while escorting me across town to the headquarters of the Chinese Fire Brigade where I lecture in first aid. Three nights ago they also turned out nicely for a dinner with the fire chief whose selection of deep-fried insects and marinated grubs revolved on the centre of the table like a carousel of horrors. With this grisly platter still in mind, I hope this evening’s meeting will be nowhere near Chinatown.

Manolo snaps at Fermin to turn off the tap.

‘All quiet! News bulletin!’ he barks.

Roadworks have begun on a new flyover and taxes will go up for a year to pay for it. Joseph Estrada, one of the country’s most popular film stars, is running for the next election and looks likely to win it. The temperature is 36 degrees Celsius with 98 per cent humidity. Heavy showers are predicted for later in the afternoon. And Silvana cookies – according to a radio promotion – now come in the flavours of coconut and purple yam. That’s all. No bus accidents, ongoing hostage situations, no gangland massacres or people threatening to jump off buildings.

With nothing better to do we mop the ambulance for the tenth time in a week. Considerably more mopping goes on here than any treatment of patients. Mopping detergent with detergent, as Juan always says. Oxygen we check too, and not because it is used for patients short of breath, but for the chance that a slow leak may have dropped the levels. This is the life of a public ambulance service medic in Manila – mopping, cleaning, sleeping …

And waiting for news bulletins.

Our meeting after work, as it turns out, is merely a visit by the rest of the station staff, three of them in all, who, out of pure sympathy for the boredom suffered by their colleagues on shift, have come to bring us a hot dinner. Sunny – a young EMT behind The Philippines Emergency Medical Technician’s Association (PEMTA), which presently boasts a total of seven members – lugs in a small television set and box of cables. He connects them up and tests a microphone with a crackly ‘one, two, two!’ Moments later we are sitting round drinking San Miguel beer, singing karaoke.

‘You have choice,’ says Sunny when it is my turn with the microphone. “New York, New York” or “Barbie World”.

Great! Cringing, I tell Sunny these are not the most interesting songs but see few alternatives in the open catalogue. Reluctantly, I ask him to start the Sinatra.

To my great relief, after just one ‘New York’ into the song, Manolo interrupts.

‘All quiet!’ he yells. ‘News bulletin!’