The Gap

by Benjamin Gilmour

  Three hours later, back at the emergency department with another case, we discover the man has passed away. A massive heart attack, a myocardial infarction. Too much of his heart muscle had died. His heart was useless; there was nothing they could do.

  Please save him, he’s got three kids … There at the roadside, before we left the scene, was the last time his wife and children saw him alive. John and I go quiet for a moment as the news sinks in. I suppose John’s doing what I am: rewinding the case in his mind, playing it again, imagining how we might’ve done it better. What if we’d arrived a little earlier? What if we hadn’t waited so long for backup to help us carry him out? Thoughts like this are torture, the line between self-assessment and self-blame tissue-thin.

  ‘Let’s not beat ourselves up,’ says John. ‘It’s not our fault. He was having a heart attack. Big man, no elevator, narrow staircase. We did our best; we did what we could. His time was up.’ John says the things we say to one another to stay afloat. It doesn’t matter if they’re true or not. To survive in this job we need to stave off the guilt with every worn-out platitude. He knows how badly I take these things. Maybe I’m softer than he is. Or perhaps I’m not as lenient on myself, not as ready as John is to shrug off the loss.

  Before we go home for the day John looks me in the eye and says, ‘Tell me truly, when was the last time you had a save? When was the last time you were a hundred per cent sure it was you and only you who tipped the balance?’

  It doesn’t take me long to answer. Twelve years as an ambo and not a single patient of mine whose heart has stopped has made it out of hospital alive. As far as I know, that is. I’ve helped save patients who weren’t breathing: some moribund asthmatics and many heroin ODs. But turning around a cardiac arrest, a patient without a pulse, has eluded me.

  My failure hangs like a cloud over every emergency call. Paramedics meet death on a regular basis and most of the time they can’t do anything about it. Knowing that survival rates from cardiac arrest are grim doesn’t assuage my guilt. Most of my colleagues have saved a few lives, and they have stories that keep them going. But not me. My confidence is shredded and I question my future.

  Worse still is letting down the long line of life-savers I’m descended from. On my father’s side there was a skilled pharmacist in the Victorian town of Craigieburn, who kept the notorious bushranger Ned Kelly alive on several occasions after firefights with police. The outlaw didn’t dare visit a hospital for fear of getting arrested. My mother’s German grandfather was a well-known fire chief in the heavily bombed city of Mönchengladbach during World War II, racing from one burning building to another, hauling women and children to safety, and picking up hundreds of bodies. My oma still has a black-and-white photo of him holding the nozzle of a fire hose like a trophy. Eventually he got dementia and ended up in a nursing home yelling ‘Fire! Fire!’ at random which, apparently, led to several evacuations his first week there. Then there was my Opa Willie, responsible for saving a boy who drowned in the Rhine River just after the war ended. His friend Fuss was swept off a sandbank and vanished. After searching frantically, my grandfather saw a scruff of ginger hair underwater and grabbed it, dragging out the lifeless boy. Without training or knowledge, seemingly from instinct, Willie cleared water from the boy’s airway and moved his arms up and down above his head until Fuss heaved and spluttered and opened his eyes.

  These were my forebears, their stories handed down to me as a child. Saving lives was in my blood, or it should have been.

  ‘There’s nothing you can do,’ says John. ‘Death’s in our stars. It can’t be tricked.’

  But it can be delayed. Others have proven it. And we’re employed to give it a shot.

  Despite his pessimism, John seems in better spirits than earlier in the day. It’s often the way; when he’s down, I’m up. And when I’m down, he’s up. I suppose it’s an equilibrium that helps us to carry on with what we have to do, working against the odds.

  CHAPTER 3

  A new life entering the world is a soothing antidote to our business of death. It can be a messy affair, but the joy on the face of a parent when I hand them a newborn keeps me going in the more gruelling moments of the job. John, on the other hand, would be happiest never doing a childbirth again. He says he has no interest in vaginas. They’re not his thing.

  And so our Friday night begins with a delivery on the toilet.

  ‘Done many?’ asks John as we near the address.

  ‘Plenty,’ I reply.

  ‘All yours then,’ he says, half-smiling.

  The emergency childbirths I’ve attended have been unforgettable. An unexpected breach, where I wondered for a while if the mother might be giving birth to an alien with a face like a bottom; a fifteen-year-old girl living with her parents, who’d hidden her pregnancy from them right until her waters broke on the kitchen floor; a pregnant woman calmly walking to the ambulance before climbing onto the stretcher and giving birth to her ninth child, which slid right out in a single push.

  The front door of the ground-floor unit is open. John follows me down a dim and musty hallway towards high-pitched screaming. In a narrow bathroom at the end of the hall we see a woman lathered in sweat, squatting over her toilet with a baby’s head between her legs. It’s only taken a minute to respond to the call and arrive on scene, but the baby’s face is an aubergine purple. Seconds count in situations like these, and I crouch down under the mother to support her newborn’s head and check for a cord around its neck. There’s nothing. I’m relieved.

  ‘You’re doing well,’ I tell her. ‘But you’ll need to give a little push now. We need your baby out.’

  She strains and grunts and curses, and it’s lucky I have a good grip on the infant because it shoots into my hands like a cannonball. It’s a relief when it happens so quickly, but much to my dismay there’s half a litre of amniotic fluid backed up, which gushes out and drenches me from head to toe. Behind me a short giggle escapes from John, who’s been watching all this from a comfortable distance. It doesn’t matter. In my hands I’m holding a pink, living baby. At least, I think I am. My vision is blurred by the amniotic fluid in my eyes and I don’t have a free hand to wipe it off. When I try to speak more fluid runs from my hair into my mouth, and all I can manage is a helpless splutter. It’s an unpleasant sour taste, this fluid, a little salty too. I spit a few times into the bathtub, then say to the woman, ‘Congratulations, it’s a boy.’

  The woman takes her baby and cries with happiness.

  ‘See?’ whispers John as we help the mother and child to the ambulance. ‘Dangerous things, vaginas. I’ll never get that close to one.’

  Not long after the job, on the way to pick up dinner, John says, ‘Do you ever feel sorry for them?’

  ‘Who?’

  ‘The babies, coming into this fucked-up world.’

  ‘Occasionally, I suppose.’

  Now and then I’ll look at parents and their environment, and I’ll imagine the baby’s life ahead. How can anyone not after seeing a heavily pregnant heroin user still working the streets, as we did last week? But then I remind myself that having a child can heal and transform a person. I hope it heals and transforms me one day.

  School’s out for the year and don’t we know it. From 10 pm, drunk teenagers drop all over the place. They go hard too early, and always fall first.

  A fifteen-year-old has been abandoned in a park by her friends. At least they called an ambulance before they fled.

  ‘Pretty slack to leave a sick friend,’ I say to John, as we load her up.

  ‘You never did that?’

  ‘Never.’

  ‘Nor would my sisters’ kids,’ says John. They live up the coast and I often hear him speaking to them on the phone with enormous affection, as if they were his own.

  A little later we find another girl lying in vomit in the well-heeled suburb of Dover Heights. She doesn’t flinch when I take a pink iPhone from her jeans. I find ‘Mum’ in her contacts and dial t
he number. When her mother picks up I hear a rowdy dinner party going on in the background. The woman is slurring her words and doesn’t sound sober enough to drive. But she says she’ll come to meet us.

  One of the girl’s ugg boots has rolled into the gutter and is drenched in spew. John fishes it out with gloved fingers and brushes it down, looking disgusted.

  ‘It’s only vomit,’ I say.

  ‘It’s a fucking ugg boot. The things we have to do in this thankless profession,’ he grumbles, shoving the offending fashion item back on our patient’s foot.

  A group of curious bystanders has formed, and I ask a girl for a hair elastic. I gather our patient’s golden locks from her pool of regurgitated pizza and make a bun of it.

  When the mother turns up we help her daughter into the back seat of the family Mercedes. I make sure she’s lying on her side for the short trip home.

  There must have been another underage party nearby because our controller sends us to a third girl found lying in the bushes further down the road. She’s conscious enough to tell us she sculled ‘a drink that looks like water’. She’s only fourteen, and this time we can’t get through to her parents. We cart her off to the Children’s Hospital in Randwick, where she can sober up. It’s bizarre pushing intoxicated patients into paediatric hospitals full of crying babies and toddlers with temperatures. The age of sixteen is the cut-off, but I’ve come across overdose victims as young as twelve. As we roll through the doors we watch protective mothers reach out to shield their infants. The impulse is understandable. Intoxicated fourteen-year-olds can be as loud and offensive as any pissed adult.

  John nods at the toddlers. ‘Wonder how many of these cherubs will end up drunk in here one day,’ he says.

  ‘Shall we pick up coffee?’ I suggest.

  It’s not even midnight and it feels like 3 am.

  An hour later we treat an eighteen-year-old man who was driving home from a party with his girlfriend when he lost control of his car and smashed into the front of a house. He’s covered in blood from several wounds to his face and is limping across the road with his girlfriend following behind.

  The accident happened in a cul-de-sac, though we guess the impact occurred at nearly fifty kilometres per hour. The solid brick house is barely damaged, but the front of the car is crumpled to the dash and there are two neat halos in the windscreen made by human heads. Chances are the seatbelts were forgotten. Although the man insists he was driving, I see long hairs embedded in the windscreen on the driver’s side and suspect it was, in fact, his girlfriend behind the wheel and that she was over the limit, so they decided to try to con us.

  ‘Any drugs with your drink?’ John asks the man when the cop has turned his back.

  ‘Just the usual,’ he replies with a smirk.

  ‘What’s the usual?’

  ‘Coke, meth, ecstasy, you know …’

  We call for a second ambulance to sort out the girl. Then we lay her boyfriend on our stretcher with a neck brace on and John climbs into the back with him. All the way to hospital the young man talks through a plot to stop his parents finding out about the crash.

  ‘I’ll tell them I put the car in the workshop. Okay, so I won’t have a licence for a while – well, so what? Dad’ll lend me his Audi for work and I’ll drive it round the block and park it and secretly catch the bus. I mean, I can do that for months, right? Months! They’ll never know. Genius idea of mine, isn’t it? Tell me I’m a genius. Hey you, ambo, you’re not going to call my parents are you? I’m eighteen, you know. You can’t call them, legally. I know my rights.’

  John says he won’t call them as long as he lies still and leaves his neck brace on and tries a bit harder to keep quiet.

  ‘In your condition, you really shouldn’t be talking,’ John advises him.

  John loves that line, it’s one of his favourites. Talking hardly ever made a patient worse. But it can certainly grate on a weary paramedic. And at this time of night John is less than tolerant of a cocky rich kid trying to squirm his way out of a situation demanding he grow up and take responsibility.

  Back at the station, at 3 am, I make us both a cup of tea, but John is snoring on the lounge before it’s finished brewing. He loves that lounge; for me it’s not quite long enough. In the next room I take off my rescue boots and lie on the bed. Getting comfortable is usually all we have time for.

  Five minutes later the phone rings and we’re up again.

  I shake John as I pass the lounge. He pushes me away.

  ‘You go,’ he croaks, hugging a little pillow to his chest.

  While paramedic work gets easier with time, our fourteen-hour night shifts don’t. Even if we’re lucky enough to shut our eyes for a moment we know that soon we’ll be wrenched from sleep again, thrown into a brawl, a cardiac arrest, a pedestrian hit by a car. These sudden shots of adrenalin, the impact of the ups and downs, take years off our lives. Or so it feels. By the morning we can look as bad as our patients. And what’s in store at the end of this career? Strokes, heart attacks, ulcers, dementia? Shift work is worse for the health than smoking. No wonder so few paramedics stay in the city as long as John and I have. So why do we stick around? Is it the buzz, the excitement of the place, the craziness we’re drawn to? Whatever the reason, it’s killing us slowly.

  John reluctantly plods down the stairs to the ambulance.

  As I step on the accelerator he says, ‘Going a bit hard, aren’t you?’ His eyes are closed and I know he wants me to cruise so he can sleep as we drive. Last week we got a call at 2 am, and when I got behind the wheel I heard the side door open and shut and there was John curled up on the stretcher. I drove to a drunk in the gutter, gave the guy a nudge and sent him on his way. John slept through it all.

  It might be tempting, the idea of sleeping on the stretcher. But it’s not for me. The blood and vomit and faeces I’ve seen it covered in makes it less than inviting.

  ‘The controller reckons it’s a traumatic cardiac arrest,’ I say, hoping this’ll wake John up.

  ‘Bullshit,’ he murmurs, eyes still closed.

  ‘I’m serious.’

  He sighs and blinks and reaches for gloves.

  In a wealthy suburb, at the bottom of a narrow, winding road, we see the flash of police beacons by the harbour’s edge. We arrive in the driveway of a mansion of gigantic proportions: five storeys of ultra-modern luxury, with glass balconies all round and an open garage containing several classic cars.

  ‘Oh God,’ John says. He’s not reacting to the opulence of the house but to the scene lit by the beam of our headlights.

  Ahead of us are two police officers doing CPR on a middle-aged woman. We get out and step over a syrupy trail of blood coming from her head. The policewoman doing chest compressions looks up at us, her ponytail flicking to and fro. She’s far too breathless to say anything. I tell her to continue what she’s doing and I snip the woman’s clothes off with my shears. John opens the defibrillator pads and sticks them on the patient’s chest: one just below the right shoulder, the other under her left armpit.

  ‘Hold it for a sec,’ he says, lifting a hand.

  Everyone stops, and we gauge the rhythm.

  ‘Asystole,’ John announces.

  A flatline. No surprises there. An occasional blip crosses the screen, the heart’s dying throes, a stray electrical charge. But there’s no pulse. The woman’s dead.

  ‘What happened?’ asks John.

  The police officers shrug. There’s a great deal of blood and the woman’s arms are flaccid, her legs at awkward angles. Like me, John’s seen these kinds of injuries before. Both of us look up at the towering mansion above.

  ‘She’s gone from the top,’ says John, shaking his head.

  It’s a suicide, most likely. But the police need to rule out an accident, even murder. Whatever the case, our work is done. The woman’s pupils are fixed and dilated and they’re staring right through us. Her injuries are, as we say, ‘incompatible with life’.

 
; ‘A quick way to go,’ says John, packing the gear.

  I disagree. It’s too hard to know. She could’ve been agonising for ages on the edge. ‘Could’ve been hours of torture up there before she went over,’ I say.

  As we sit in the ambulance writing up the paperwork, a cop comes over and asks John if he’ll speak to the husband. John nods reluctantly. One paramedic will always have to impart the bad news, and tonight I’m the driver so it’s John. I step out and follow him into the house.

  The woman’s husband, flanked by two constables, is waiting for us. John doesn’t speak; his face says it all. The man crumples to the floor, crying like a child. John crouches down beside him, puts a comforting hand on his back. It’s all he does: just a hand, resting there. A minute goes by before the man gets up again. John guides him to the street, past the body of his wife covered with a sheet, across the river of blood. I go to pull the sheet off in case he wants to say goodbye. But his face is wracked by such terrible grief I know he doesn’t have the strength to see her now, not in the state she’s in. John almost carries him to the police car. The man will go to the station and make a statement, ring some relatives, friends. Meanwhile, the forensics team will photograph his wife where she lies before the contractors take her off in their van. After that, if they think of it, the constables guarding the scene will hose her blood into the harbour.

  ‘Glad it’s us tonight,’ says John when we’re back in the ambulance. ‘Others might’ve worked on her.’

  ‘Dreamers,’ I say.

  ‘So glad you’re not a hero,’ he says, driving away.

  Honesty is the least we can offer. I’ve always felt uncomfortable trying to revive the patients we know are too far gone, all for the sake of the loved ones. Do we ‘go through the motions’ to show we’ve done our best? It’s a nice idea. But does it help? Is it ethical?