I can still recall every detail of the diabetic coma. The way his body shone with a ceramic whiteness, like he was somehow being vitrified before our eyes. Turning to rock. Swollen and dense and clammy. Each breath a rasping cry for help.
Normally when you turn up at a job, someone is waiting. But the entrance to this huge rest-home was dark, not a soul stirred. When finally someone answered the bell, they had no idea that’d we been called to a Priority One, that a patient of theirs was hovering near death.
By the time we found him we’d been joined by an advanced paramedic. Every metro shift has advanced paramedics floating about in control vehicles that can be called as backup.
And I watched as the team swarmed over the patient in the tiny room, attending to him with controlled, clinical ferocity. Airway cleared, oxygen mask attached, blood-sugar test jabs, bags torn open, drips inserted, blood pressure tested—all in this cramped room, all with perfect clarity. As they worked, I could see the ceramic pallor being flushed from the body by the refreshed chemistry of his blood.
Soon enough he regained what are truly the signs of life—he started to breathe with ease, his eyes became focused and responsive, he could answer questions. To me, this was a miracle of life literally returning—but the advanced paramedic allowed only that late-stage diabetic coma results can be “quite spectacular”.
This was about five years ago when I spent a few weeks riding in the trucks. I’d reported a story for 60 Minutes which showed St John resources being spread so thinly that people were dying. I discovered then that six minutes was the gold-standard response time for cardiac arrest—after which survivability plummeted—but that 75 per cent of St John’s responses took longer. But despite the difficulties of funding and resources, I was so impressed by the people on the ground that I wanted to find out more about the job. At its heart is the chance to transform the fortunes of the people you are called to help.
But the intervention is not always medical. Take the day we were called to some pensioner flats where a resident hadn’t been seen for days. Neighbours reported a bad smell. They feared the worst. As we sped through the streets I couldn’t help thinking it was a little late to be calling us. The neighbours showed us the door. We strapped on facemasks and let ourselves in. We could see the little unit was in perfect Bell Tea order, right down to the carefully stowed knitting by the Conray heater, the Woman’s Weeklys, the lace curtains. But something had gone terribly wrong. We were hit by a stench that even through a facemask required careful mouth-breathing, and the air was filled with blowflies droning like a Battle of Britain aerial raid.
They seemed to be coming from the bedroom. And that’s where we she was, lying on the bed, her arms emaciated, pencil-thin. She must have died in her sleep, I thought. And then her milky-blue eyes swivelled in their sockets and she raised a hand. So if she wasn’t the source of this awful rotten-corpse smell, then what was? On the wall above her bed were photos of a dashing young man in uniform, a wedding, a baby. Grown children. The milestones of life. Had her husband died?
Check the bathroom. Nothing. I opened the opaque shower door with huge trepidation, but again nothing. It turned out that she lived alone, and had been widowed for years.
Eventually we pulled back the bedsheet and there, cuddled next to her, were the putrid remains of her dog, its teeth bared in rictus. It must have died many days ago. She simply didn’t want to let go. Not ever.
And now the challenge for any emergency worker: how to find the discipline to transcend your own shock in an instant. Move forward. Gently disentangle her from the dog. Ignore the maggots, the thick cloud of blowflies. Get her out of there.
As the crew cleaned her and gave treatment for severe dehydration, she apologised for doing the wrong thing. No, we chorused, perfectly understandable. Don’t you be worried. We bundled the dog in the bedding and popped it into a wheelie bin. A kind of burial.
And so with fluids restored and pumped full of bright words of encouragement, the weight of those awful days of mourning seemed to lift. Our company had broken the spell. By the time we reached hospital she was sitting upright, chirpy as a bird.
“I am so naughty,” she told me. “No,” I said for the twentieth time. “You loved your dog and you did the right thing.” “Oh, no,” she said, “I’m not talking about that. I could really use a bourbon and Coke!”
Although it hadn’t been an easy job—at one point I dry-retched—being there in some capacity at that low point of her life, and being able to assist with the transformation of her spirits, was a privilege.
I saw that sort of transformation on virtually every job—from the very first call, where a young husband dialled 111 because his late-term pregnant wife wouldn’t stop bleeding. The way his look of terrible worry and anxiety softened with relief as the crew took on the burden.
One advanced paramedic, Phil Keller, put it this way: “Taking on that responsibility, you feel humble it’s you they turn to. But when you first start the job you also feel scared. In class you might have no problem getting an intravenous drip into a mannequin, but the squiggly, tiny veins of a dear old nana, that’s entirely different. You’re this young green kid and you carry their trust on your shoulders.
“That’s where training and adrenalin kick in and that’s where you learn to slow down and think. But it still humbles you being there with that responsibility.”
Even the simplest procedures contain mystery. I can still feel the throb in the veins of the first patient I took the pulse from. He had high blood pressure and his veins stood out on his bony wrist like pumping blue hose. Or the next job, where an overweight patient with a heart problem could produce only a faint and feathery pulse. I learned that crucial information can be gleaned from touch, from your fingertips.
I learned a lot in those few weeks, and what I learned stayed with me. And this year came a test. Along the road in a lonely southern Californian canyon I encountered a trail of motorcycle wreckage. I caught sight of the rider slammed like a rag doll into the roadside rocks. The only other person there was standing beside his car, frozen to the spot, too horrified to help.
I could see why. The rider’s face was a mask of blood and grit. From the extreme angle of his neck it seemed unlikely he had survived.
When I got to him I could hear a snorkelling breath. His uselessly small helmet had been knocked to the back of his head and the strap was biting deep into the flesh like a garrote around his throat. I cut the strap with the knife from his belt, hooked the bloody mush out of his mouth and eased his airway. Within 10 minutes, Fire Service paramedics had arrived.
Coming across this motionless body was a heart-stopping moment, but there was no one else able to help. Moving forward, knowing that some stranger was depending on you for a fighting chance, is a scary thing. But the focus and intensity and slow-motion calm of that moment—there’s no feeling like that in the world.
This is the daily stock in trade of the “ambo”. Said one: “It hits you that this is actually singularly your responsibility. You have to find a way to be calm and decisive. There is a satisfaction to it, like knowing about a personal strength. And then with this job you are extending and challenging that ability.”
I joined the Fire Service as a teenager for those same reasons—to save lives, to make a difference. But it was the ambos who were doing that work more frequently. At car extrications, with trapped passengers, it was the ambos who had responsibility for their lives. And every so often they’d drop by the station to grab a tea-break—goggle-eyed, gobbling sweets, guzzling high-octane coffee. Then they would dash off into the night, answering another call for help. Who were these guys?
Nowadays they’re just as likely to be women. Shaini Healy has a story typical of most. She trained as a nurse but joined St John as a 20-year-old volunteer. Her interest in emergency medicine was sparked by being first to arrive at a head-on collision when she was 15 years old. “There were six people—five thrown from a van, with one woman pinned under the vehicle, and one trapped inside the van itself. People say that sounds ghastly. For me it just kind of clicked—I felt calm, I felt I could help.
“For a few days after the crash I really struggled. It all felt abnormal and surreal. Then I realised it was a challenge I had faced up to; there was a pride.”
The job is all about that challenge. And the biggest of all for many ambos is witnessing the circumstances in which some children are forced to live. One hot spring afternoon we were called out to a private home, but despite the heat, every curtain was pulled tightly shut, every window hermetically sealed. The air itself was rancid—it felt almost encrusted with tobacco and dope and cooking fat—and the floor was littered with cigarette butts and, oddly, peanut shells. In the gloom we could make out a young woman dumped in a corner of the kitchen floor like a plastic rubbish sack.
A gauntlet of bedraggled male occupants watched us with predatory eyes as we moved forward to treat this woman, who was barely out of her teens. One of them started telling me that he knew what to do when his partner had a fit. He’d been there for her right from the beginning, through thick and thin. He ran a greasy tea towel under a kitchen tap and placed it on her forehead. The girl was the age of my daughter.
I made a silent prayer: Please God, don’t let there be children. But of course there were. This drug-user and this comatose young woman had already brought four kiddies into their world. I gained the sense that if the cops—there to make an arrest —hadn’t called us, no one else would have.
There’s no predicting a day. Waiting for a call, there’s a sense of suspended readiness—an anticipation of the bells, of the need for instant focus.
On one day we go from the old lady and her decomposed dog straight to a swimmer stunned by a jetski ridden by a strip club owner (the splendidly named Brian Le Gros) and, later, to his club to attend to a very pale and unwell dancer, delicate in the darkness like a fawn, surrounded in the murk by leering men. And always, the old people in their houses in the middle of the night. Their cosy, domestic enclaves of certainty—the La-Z-Boys, the slippers, the china cabinets—now invaded by calamity. Their porch-lights beckon us through the night.
Ambos often spend their 12-hour shift running from job to job with very little break. At least now the Fire Service is often called in to help out. Back when I was a fireman, it had always bothered me that somebody could be dying of heart failure next door to a fire station and we wouldn’t be called. It seemed then like the worst kind of patch protection. It’s entirely logical that the Fire Service, with three times the number of stations nationally as the ambulance services and response times that are far more rapid, should be used much more consistently. The problem is that patients are still at risk because firefighters cannot provide the same standard of care as trained paramedics. St John estimates that its funding needs to double in the next few years if it is to provide gold-standard service for the expected growth in demand.
But no matter how much funding is available, on every ambo’s shift is the prospect of having to deal with death. I rode a few shifts with Mat Delaney. In his twenties, he’s been an ambo for three years.
“There are still jobs that get to you,” he says. “I had a one-year-old choking on a grape at his birthday party. We tried and we tried and we couldn’t quickly remove the obstruction and the baby didn’t make it. For a few days I couldn’t get that out of my head. You have to accept people die—we all die—and it can’t always be helped.
“A little while ago a boy hanged himself under his parents’ house. Although we couldn’t revive him, I walked away from that with satisfaction. With the dirt under the house and in the difficult circumstances, I know I did everything right.
“You just can’t have expectations. If you tried the caped-crusader thing, you wouldn’t last. Of course, in the back of your mind you hope that it’s going to work, but we don’t have a magic wand…”
Talking to Mat, I recalled the grief of my first failed rescue, long after I left the Fire Service. A tiny Mini had collided with a Ford Falcon on the Desert Road and an old woman was pinned by the steering wheel. I hitched tow-ropes to the Mini and used bystanders’ cars to pull the wheel from her chest. It was a trick an old ambo had told me they used before the Fire Service had vehicle extrication teams. But nothing could save her—not all the hope and care in the world.
And now riding with St John, the first “do not resuscitate” (DNR) case I encountered was an old sailor with tattoos fading into the wrinkles of his skin. On the walls of the rest-home unit were photos of ships and seafaring mates and family. I complimented him on the fine vessels. He politely acknowledged my comment but I could see his focus was not on life. He just wanted to go into that night.
It was at the hospital that I saw the DNR legend scrawled across his form. There’s a deep and unexpected finality about that. Here’s someone you are speaking to, who is alive and human, but they’ve made the choice they are tired of the battle, that their spirit needs to rest. If this work is about saving life, it’s also about accepting death.
On my last night riding with Mat, I encountered another DNR at a rest home. To reach the patient, we were led down a darkened corridor. On the doors we passed were names of a different time—Valmai, Rona, Thora, Eunice. The names reminded me of my own mother, Elsie, who died 20 years ago, pleased to escape ending her days in a rest home.
Some of the doors were ajar, and in the half light I could see in the rooms a clutter of memories—cards, photos, china figurines selected from grand collections, remnants of some past life. I couldn’t escape the feeling that these rooms, one after the other, were like crypts for the living.
Our patient, in her 90s, was suffering heavy gastric bleeding from an agonising stomach cancer. She was in danger of bleeding to death. Marked on her door, amid the heavy rest-home smell of oranges and floor polish, was a name I knew from my childhood. Trix Tingley was a bosom buddy of my mother’s.
With one surreal step I entered a time capsule of the beginnings of my own life. Watching down from every wall were photos of her daughters and my neighbourhood. Photos of the Trixie I remembered, with her quirky, sharp smile. It was odd seeing her now, shrivelled and tiny. Age, like some abstract artist, had reduced her face to a series of lines drawn in drapes of tissue-thin cloth. But the essential qualities of her character were all the stronger. Somehow I wanted my own mother in the room with us.
But now it was about making Trixie comfortable for the journey to hospital, possibly her last. With so much blood loss, it was decided to insert an IV drip to restore her fluid levels. In an utterly slow-motion reflex, she offered a forearm to Mat’s crewmate, Lyndsay Hufton. He worked the needle carefully under skin that seemed thinner than cigarette paper. Few needlepoint masters could do finer embroidery. He tried first one forearm and then the other, but her veins would no longer accept a needle. Mat also made an attempt, but it was obvious that continuing would cause more discomfort than the relief the IV fluid would provide. So we set off for hospital.
Lyndsay turned off the light to reduce the glare, and fussed over Trixie’s every comfort. I sat in the back of the ambulance, awe-struck at how 60-year-old Lyndsay, 36 years in the business, remained so compassionate and committed. The pair of them had met her every need with the sweetest care and respect, something I felt strangely proud to convey to her family.
Later, Mat would tell me, “You know this could be their last trip. Maybe you will be the last person they speak to. You never forget that when it happens. You connect with them but you know and they know they want their life to be over. And that is an honour to be there and do the job to the best of your ability. For them.”
In the back of the truck I could see that Trixie had both palms upturned. There was a sense of supplication, of inestimable exhaustion, of deep peace, perhaps a marathon almost over. At the hospital, I took her hand in mine and offered her my best wishes, from our family—the best I could do. And from her eyes came a spark of impatience that was pure Trixie. “I can’t do with much more of this,” she said.
Hours later, at 2am, and just as we hit the wall of exhaustion, came a call to another elderly woman in distress. Driving through the night, foggy with fatigue (we’d done eight hours straight, with another four to go), we finally located the address down a long right-of-way.
We could see through the open ranch-slider a tiny waif slumped over the kitchen table in a strawberry-pink brunch coat and fluffy slippers. Worried that she hadn’t responded to our knock, we entered. Why was she hunched over the table? And why the snuffling noise? With her chin inches from the plate, we discovered that, lost in concentration, she was busily scoffing a great mound of apple pie!
She continued to cram pie into her mouth as Mat and Lyndsay attempted to diagnose her. Her voice was slurred from the effects of a sleeping tablet, but they finally established that her legs were aching—a chronic complaint, but no emergency. They very carefully confirmed her health details and medications. And although she’d carefully packed her suitcase ready for hospital and was feeling a bit lonely, she agreed that maybe a paracetamol and a good sleep might be the best answer.
Together the ambos chimed words of reassurance. “What if we just pop you into bed. You won’t be very steady on your feet, will you? That’s the love. We’ll pop your pie in the fridge and you can finish it tomorrow. Have it for breakfast.”
No sooner had her head hit the pillow than she started snoring like a tractor. It’s then I catch Mat and Lyndsay shooting each other a little grin, pleased that she’s comfortable. It’s a moment of great kindness, there at 3am, that says it all. We turn the porch light off and lock the ranch-slider. Nobody in this quietly sleeping street even knows we’ve been, except for a lonely old nana, curled up happy as a kitten and dreaming of pie.