The Gap

by Benjamin Gilmour

  ‘Shady? Is Shady there? Tell Shady I’ve been in a really bad accident. Oh, he’s there? Okay, put him on. Shady, is that you? Shady, yeah, you’d better sit down, mate. Just sit down, okay, find a place to sit down, trust me. I have to tell you something and you might wanna sit down to hear it.’

  The guy isn’t joking.

  John leans into the front of the ambulance and says, ‘You think his ankle might be front-page news tomorrow?’

  ‘Up there with the war in Iraq,’ I reply.

  When the guy gets off his phone John offers him pain relief.

  ‘Oh, God yeah! Dude, the pain is, like, so bad, like, I really can’t take it. I mean, I don’t want to be a hero anymore, know what I mean?’

  In my rear-vision mirror I see John looking earnest. ‘You’re right,’ he says. ‘Even heroes need a break. Let me give you some morphine.’

  ‘Morphine?’ He seems surprised.

  ‘You did say your pain was, like, so bad, right?’

  Little does the guy know that John is probably giving him pain relief in the hope it’ll quieten him down. It’s what I’ve heard some doctors call a ‘shut up’ dose.

  We treat a performer at the casino after that, a fire-breather called ‘Jaguar’, whose hair has caught alight. Then a short time later we go to a man hit by a taxi near The Pleasure Chest, an adult store in the Cross. He’s unconscious on the road.

  I can see John’s tired and it’s only 11 pm. While I manage the patient’s airway, John takes out his trauma shears and cuts along the seams of the guy’s leather pants and jacket for better examination. Cutting along seams is no obligation, just a courtesy so motorcyclists and leather-bound men can get their garments sewn up again.

  But when the man wakes in Emergency a few hours later, he turns out to be highly abusive, cursing and spitting at the nurses.

  ‘And there I was, saving his jacket,’ says John with regret.

  The senior nurse overhears him. ‘Don’t worry, John darling,’ he says. ‘The guy was such a fuckwit we shredded his leathers in the pan room.’

  John laughs, out loud. It’s the first time I’ve seen his face light up in weeks.

  I hang around the triage room as John completes his paperwork. I see an altercation developing between two of the casualties waiting to be seen.

  ‘Mate,’ says one to the other, ‘you got blood on your head.’

  ‘Yeah, well, guess what? You got blood on your head.’

  ‘Are you fuckin’ with me?’

  ‘No, I’m not fuckin’ with you, idiot. What I said was you got blood on your head!’

  ‘For fuck’s sake! I was just telling you that you got blood on your head and now you’re fuckin’ with me like some parrot.’

  ‘Parrot? You calling me a parrot? Ah, just shut the fuck up.’

  ‘Yeah?’

  ‘Yeah.’

  It’s about to get physical. When I see security approaching I let myself out. There’s always entertainment in the triage area. The hospital ought to sell tickets for seats on Friday and Saturday nights, perhaps to raise funds for much-needed equipment. Few live shows I’ve seen come close to the hijinks of Accident & Emergency. Only last week a girl off her chops on ecstasy amused us by making rounds of the department hugging and kissing every other patient, telling each one how beautiful they were and how much she loved them. For many, the care and attention she delivered was all they really needed. Even John got in line for some love. The girl hugged him for a good minute, as if she could tell he needed it most.

  At midnight we bring in a sweet old woman in velvet slippers and floral nightgown who smells like lavender and stale urine. We suspect she has a UTI. We don’t have a choice but to put her next to an agitated man affected by amphetamines and covered in sores.

  John startles the triage nurse with his deadpan handover.

  ‘This is Phyllis, seventy-eight years old, picked up from a rave dance party after taking speed and acid.’

  The nurse knows John too well. She giggles and playfully slaps his arm. My partner’s sense of humour and his friendship with staff once again win us a bed for our patient. As we hand Phyllis over I feel the night is about to ramp up. Another crew arrives doing CPR on a man while a guy in the waiting room punches the triage window, yelling, ‘Do I need to be shot to get a doctor?’

  We slip out the doors and back into the ambulance.

  Kings Cross is getting busy and our controller wants us down there. Revellers have spilt onto the road, and we creep along carefully. By this time of night no one seems to care about the traffic anymore. Alcohol has claimed the streets. Distracted by strippers in dressing-gowns outside Showgirls, I almost run over an old man with a walking stick who’s crossing in front of us.

  ‘Look at this guy,’ I say to John. ‘He’s at least eighty, cruising the strip at 1 am.’

  ‘Viagra,’ says John.

  Further down the road comes another unlikely spectacle: a family as wholesome as the Brady Brunch going into a strip club. There’s a neatly groomed dad, well-dressed mum, teenage daughter and two teenage sons, all sauntering casually into the Pink Pussycat as if it were McDonald’s.

  ‘Tell me that’s not strange,’ I say.

  ‘Not at all,’ replies John. ‘It’s little Jimmy’s eighteenth, and this is what he’s been wishing for, or maybe his dad thinks he needs to see a strip show, you know, to be a man.’

  But what about the mother and sister? The scene reminds me of a family in Maroubra charged last week with illegal graffiti. Both parents and their kids were caught by police with spray cans and marker pens tagging walls at 3 am.

  As we turn into Macleay Street we see a policewoman we know dragging a rough-looking man into a cage truck. I wind down the window and call out to her, ‘What’s going on?’

  ‘Motherfucker spat in my eye!’ she barks.

  We keep driving and a trans woman dressed like Amy Winehouse, in a tight zebra-print pencil skirt and silver stilettos, gives us a wave. John waves back. Then I swing into a darkened laneway for a loop of the block but have to slam on the brake to avoid hitting two big men, one giving the other vigorous oral sex.

  ‘Laneways are a thing, you know,’ says John, matter-of-factly.

  The men ignore the beam of our headlights and carry on their antics without the slightest effort to let our ambulance pass. I’ve no interest in watching them, waiting for them to finish, so I back out of the lane with a screech of tyres.

  We attend a patient in a dark apartment filled with cigarette smoke after that, a man who’s ‘not feeling normal’. John asks him to define ‘normal’. He can’t, and nor can we. The man gets a check-up all the same. Then we pick up a woman lying in a gutter, so drunk she’s soiled herself. We cocoon her in a blanket with just her arm exposed for a drip, and give her some medicine to stop her from spewing. It’s one less thing we’ll have to mop out.

  When the ambulance has been properly sanitised, we’re sent to Taylor Square for a man at T2. It’s a dance club where people can party for days, their eyes kept open by drugs and Red Bull. Our man complains that he’s too tired to stand and wants to be carried.

  ‘Been dancing since Friday,’ he says with a groan.

  But he’s embarrassed to be leaving the club on a stretcher. John suggests he pull the bedsheet up over his head to hide his face from the queue outside.

  Lying motionless and shrouded, our patient sparks momentary pandemonium in the line-up as we leave. It appears to the crowd that we’re carting out a corpse.

  ‘Oh my God!’ shrieks a man, clutching his face in horror, as two girls start wailing. In no time at all, the queue has dispersed.

  By 5 am, things have quietened down and the hordes of wasted punters have mostly drifted off, leaving a trail of fast-food junk and pools of vomit in their wake. It won’t be long before an efficient team of cleaners wielding high-pressure hoses blitz the footpaths. By 7 am, there’ll be little evidence left of the night’s drunken carnage, as thousands of tourists
leave fancy hotels with their cameras and bumbags, ready to explore this postcard-perfect city.

  We don’t see a soul on our return to the station. At this hour Bondi is more like a country town than Sydney’s busiest beach, five minutes from the CBD. We’ve emerged from the city’s underbelly and into the light. As a hint of pink dawn appears in the sky we think we’re finally done.

  But it’s not to be. There’s one last job to see us off. Up at The Gap, our second home.

  While walking his dog, a man has found a pair of running shoes by the edge of the cliff. There’s a car in the no-stopping zone too, keys in the ignition. It’s a $300 ticket if you’re caught in that spot. No one takes the risk unless they’ve decided they won’t be around to pay the fine.

  Our eyes are blinded by the sun heaving itself from the ocean. We squint against the glare, scanning for a body in the waves below. But there’s only the gold of sunlight on water.

  ‘Too hard to see,’ I say.

  ‘Might have gone under,’ says a policeman who’s arrived just behind us.

  ‘Might never come up,’ says John.

  The air is fresh and clean and cool, the air of a new day. I inhale deep breaths the way Jerry does in the mornings, and with each one I feel the heaviness of my night lifting away.

  CHAPTER 7

  My mum and dad are worried about me. They call up in the morning to make sure I’m getting sleep, that I’m eating enough fruit, all the usual things. My mum reckons I sound depressed; her instincts are good, but I don’t feel too bad. She drives over the bridge from Lane Cove after lunch. She wants to check on me in person and brings a casserole and my favourite ginger cake. She knows how miserable I get on my own. I’m sure she still remembers how badly I took breaking up with my first proper girlfriend at the age of eighteen. Back then I was so depressed I couldn’t eat for a week. But that was before my chosen line of work gave me a suit of emotional armour.

  Mum tidies my kitchen a bit and we have a cup of tea. She asks about Kaspia. I tell Mum I haven’t seen her in a while but urge her not to worry.

  ‘It’s just a trial separation, a short break, that’s all.’ She’s probably taking this harder than I am. Mothers often do. A while back she warned me not to take Kaspia for granted. She said, ‘A relationship needs attention like a flower needs water.’ And she knows about gardening; her garden is abundant. But I guess I didn’t listen.

  I tell her it’s time I got ready for work. We hug and she leaves. Then I set up the ironing board to press my shirt and trousers.

  My second night shift with John starts simply enough. A nursing-home patient with constipation, another with pneumonia.

  The next one’s a little trickier. I follow John up a flight of stairs to a top-floor apartment. The door is open and we find a man in a suit and tie sitting at a table eating his dinner with silver cutlery. His name is William, a retired doctor. We call out from a metre away, but he doesn’t look up. William’s wife, Margaret, has her back to the wall. She’s visibly shaken. In a quivering voice she tells us that her husband, to whom she’s been married for fifty years, has Alzheimer’s and he’s been rapidly going downhill. Within the past month his behaviour has become aggressive, violent even. On this occasion, according to Margaret, he pulled a carving knife from the kitchen drawer and held it to her throat. He threatened to kill her if she didn’t cook him his favourite meal: steak and gravy with green beans and potato gems.

  ‘But I didn’t have any beans!’ she cries.

  John puts a comforting arm around her. Meanwhile I approach her husband, who continues chewing his steak as if we’re not in the room.

  ‘Excuse me, William,’ I say, leaning down. ‘We’re paramedics from the ambulance service. Is everything okay?’

  He must have heard, but he doesn’t react.

  ‘Your wife’s called us because she’s frightened. She says you threatened her with a knife.’

  This time he stops eating and looks at us with irritation.

  ‘Who the hell’re you? What’re ya talking about? I love my wife! We’ve been married fifty years. I’d never do that!’

  ‘William!’ his wife calls from the corner, her voice trembling. ‘You said you’d kill me if I didn’t give you beans. Don’t you remember? You had a knife.’

  He starts eating again and shakes his head. Through a mouthful of potato he grumbles, ‘She’s a crazy woman. Don’t believe a word she says. Can’t you see she’s trying to get rid of me? After all that I’ve done for her. It’s a bloody disgrace!’

  By this time William’s wife is crying loudly into John’s shoulder. Framed black-and-white photos on the walls show them as a beautiful couple embracing on a park bench at Circular Quay, sometime in the fifties. In another they’re standing on the deck of an ocean liner, dressed in loose whites for a Pacific cruise. Smaller pictures of children and grandchildren are propped up in rows. Laughing faces at barbecues and parties and graduations. As I move through their private exhibition and delve deeper into their history, I wonder at how tragic an end this is to such a meaningful relationship. I’m filled with pity as we finally convince the old doctor to come to hospital.

  ‘Stupid cow,’ he growls as we lead him out.

  When I look back at Margaret and see her weeping in John’s arms, I swear there are tears in John’s eyes too.

  An hour later, a twenty-one-year-old woman in Rose Bay calls us for a sore throat.

  ‘Do you have a lozenge?’ John asks her.

  ‘A lozenge?’

  ‘A lozenge. We don’t stock them unfortunately. Do you have one?’

  ‘Maybe. In the kitchen drawer.’

  Our patient makes no effort to move from the bed. I wander into her kitchen and open her kitchen drawer and see a packet of Strepsils. I bring them back to John. With no detectable sarcasm he asks the woman, ‘Would you like me to pop one in your mouth?’

  ‘Yes please,’ she replies.

  It’s only natural to be frustrated by inappropriate emergency calls. But at some point I realised this frustration never improved anything. It just made me feel lousy. In any case, the smallest ailment looms large for some people. They may not have the faculties to manage this stress, or to think of other options. They also don’t know the wider consequences of their call. No one’s told the woman with a sore throat that she’s tying up the only available ambulance in a fifteen-kilometre radius. Or the woman last month who called us for pins and needles in her leg after her Labrador had slept on it.

  ‘How’s the lozenge?’ John asks before we go.

  ‘Good, thanks. I feel much better,’ our patient replies.

  We wish her a speedy recovery and drive away.

  John tells me that he’s almost used up his nightly ‘quota of sympathy’. It’s not even 9 pm.

  ‘Two hours in, compassion level low,’ he reports. That’s when we get squeezed the hardest, of course.

  The next address is all too familiar. It’s the residence of two former nurses, a couple who’ve made an art of being unwell. They are, as one doctor at a local hospital put it, ‘a pair of munchies’. In other words, sufferers of Munchausen syndrome, a condition in which people feign illness, disease or mental trauma to attract sympathy.

  The man is well dressed and well read. He’s articulate, and patronising. His wife is an actress par excellence. Both have years of experience nursing on general wards and know all about sickness: how it’s done, what investigations and procedures ought to be conducted, what they’re entitled to by law, the words required to get it, and how medical staff should behave. Their luxurious home, bought recently from money generated by another medical negligence settlement, is packed with physiology books and medical journals, up-to-date research on new and exciting illnesses. They are never simultaneously unwell; the roles of patient and caregiver swap from week to week.

  When their varied medical complaints cause them pain, there will never be quite enough analgesia we can give them. They always want more, and running out of
morphine from our kit is not uncommon, despite them having plenty of their own. They’re on just about every pain reliever on the market and they have been separately admitted for opioid overdoses. Both are under sixty years of age, but each has a pill list longer than the average ninety-year-old. These pills are heaped in packets on their dining-room table, all from different doctors and pharmacies.

  It’s hard to know how to help this couple exploiting the health system for sympathy, drugs and money. If they fail to get attention they pen long letters of complaint and threaten lawsuits, several of which they’ve won.

  John groans. ‘Which one is it?’

  Our data terminal says the patient is female.

  ‘It’s her,’ I say.

  ‘Her?’

  ‘Her.’

  John closes his eyes. ‘No, no, no. Not her! I can’t do it!’

  He decides to use his ‘wildcard’.

  Some paramedics in the city have been using the informal wildcard system for years. No one knows who began it, but it goes like this: if the treating paramedic wants to get out of an unpleasant task, they can turn the job over to their partner by simply saying ‘wildcard’. Problem is, in any given shift, the treating paramedic has just one wildcard to play. I, for instance, might use my wildcard for a vomiting patient. Vomit’s not for me. Blood is fine. In such scenarios, I play the wildcard and my partner steps in. This wouldn’t be so bad were it not for the fact that John can use a wildcard just as easily as I can. For this reason, not everyone likes the game.

  We go in and the woman’s on the ground with a painful knee, as she often is. She’s on fentanyl patches and other powerful drugs, but still begs for morphine. We’ve been through it all before. Denying her request guarantees a complaint, and the time and stress involved in answering it and waiting for the outcome simply isn’t worth it. While John sets up the stretcher I give her the morphine, and we carry her out. We don’t mess around. Some of us call it a ‘short back and sides’. In and out, load and go. It’s the best approach for critical patients as much as it is for calls near the end of our shift, or for patients we want to spend as little time as possible with.