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CHAPTER 1

GROWING PAINS

And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. – Anais Nin

Some lessons come easy and some don't. Sometimes the line between being a paramedic keen to treat sick patients and being a heartless, arrogant twat gets a little blurred before we gain emotional maturity. At some point in the first few years in the job I learned to rein in my reaction to the 'big one', because a great day at work for me is often the worst day in someone else's life.

We find ourselves in Sydney's Wentworth Street; it is midmorning. I'm a junior primary care paramedic and keen to get down and dirty.

'Four-two-four thank you, you are responding to a hanging – no further details as yet,' the dispatcher says in a stern monotone over the airwaves. Oh cool, I haven't done a hanging in a while, let's go, I think, as a wave of excitement rushes through me.

With smoking tyres, my partner Belinda and I hightail it to the scene of this 'big' job. In ambo language, this equates to a 'good' job, usually. We like the big jobs, the sicker the better, some say. It may seem like a crazy mentality, but when we train for these events and prepare ourselves it's the big jobs that test our skills. We get to see first-hand what all the studies and textbooks say about trauma, illness and injury; we get to enact our protocols and see the concrete effects of our treatment. It feels right, and even more right when there is a positive outcome. We wait for this work and spend countless hours preparing for it. It comes unexpectedly of course, when that call comes through: we might react with excitement for all these reasons. We're not sickos; it's just how we're wired.

For now I'm green enough to be hungry for big jobs, a hunger that peters out over time for many ambos as the psyche fills up with so much sadness that any more might make you burst and leave a mess too big to clean up.

As we jump the median strip and weave our way through King Street in Newtown, Belinda is herding the traffic like sheep. It's the closest either of us will come to country life and we laugh out loud at the frantic dash people make to clear a path for us. I lazily pull on a pair of our unmistakable blue gloves as Belinda navigates her way through the back streets.

'Do you want me to look it up?' I offer, already opening the famous Gregory's street directory. The heavy workload in this area is obvious – the pages for Newtown are tattered and marked with notes by other ambos. There are circles marking regular addresses and the occasional skull or cross.

When I trained, map reading was a vitally important skill – and a huge source of anxiety when working outside the normal catchment area. It wouldn't be unusual to see an ambo steering the truck with one hand while juggling the Gregory's in the other. We'd write frantic notes on the back of latex gloves, indicating how many streets to pass before turning right, then left, then the second exit at the roundabout before travelling a further kilometre, my goodness, and so on. This was how we tracked down the sick and injured.

These days we have the luxury of GPS, and just about every smartphone has a voice-activated map navigator. Navigation systems are also built into the ambulance. What a relief it is to set out knowing we're headed in the right direction on the quickest route to our patient without the added stress of having to refer to the street directory.

'No thanks, mate, this address is right near my place, I can get us there,' Belinda replies. That's never a good thing; one always ponders the possibility that an address near home will involve a neighbour or friend. We've all heard the stories, the unbelievable nightmare of treating your own family. I hope this isn't anybody we know, I think, and with that thought my excitement eases to moderate anticipation. I am still stoked to be on this job, but maybe I'm not punching the air.

In all of seven minutes we pull in for a tidy approach and I remark, 'Nice parking, sister!' as we step out of the car in perfect unison. We're greeted by the familiar smell of burning brakes and the unfamiliar sound of flowerpots being launched from an upper storey balcony. Distinct cries of terror and grief echo around the buildings, which stand as icy witnesses to the day's events. The screaming and smashing pots indicate we're in the right place and that it shouldn't be too difficult to locate the patient. Like a magnet, it draws us closer.

'Okay, so we're up there, I suppose,' I say. I hope they can buzz us in, I think, completely absorbed in the logistics of getting to a higher floor in an apartment building.

The gear feels weightless as we stride up three flights of stairs. We know it's a hanging but we still don't know the state of the patient, which means all the gear comes with us. A twelve kilogram vinyl backpack known as an Oxy-Viva comes with us; it's complete with an oxygen cylinder plus every type of oxygen mask we use and a cardiac monitor and defibrillator, known as the Lifepak, in case the patient is in cardiac arrest (often futile really, due to the fact that the patient's brain has been starved of oxygen long enough to cause cardiac arrest; we can often restart the heart but we will never save that brain). Then there's a relatively lightweight bag containing at least five or six cervical collars that provide a rigid support to the neck if we suspect it's broken, which we always do in a hanging. There's a drug kit that's like a large suitcase and also weighing in at about twelve kilograms, and a spineboard that looks like a large, flat surfboard to keep the patient flat in cases of suspected spinal injury. It all comes with us to the patient.

I want to take the stairs two at a time but I control the internal urgency and take a steady walk to the apartment. My partner is right behind me. I'm the treating officer today and the intensive care paramedics are a long way off. By that I mean ten to fifteen minutes, which can seem like eternity when you're out of your depth.

With one more flight to go, the screaming becomes more intense. It's too early and too cold to be breaking a sweat, I think. Why is it always up the top? I think to myself as I walk as quickly as possible with the gear to the patient.

'This way, ambos!' a police officer calls to us as he strides ahead and leads the way up the stairs. We are just a bit slower on our feet; it might be the forty-odd kilos of equipment we're carrying, or the fact that at the time we're both heavy smokers. I'll blame it on the equipment: it's bulky and cumbersome, a fact almost every greeter at a scene overlooks.

Apparently everyone is oblivious to the hysterical young woman who seems to be having some sort of psychotic episode on the balcony. I don't get a chance to check for epaulettes on the shoulder of his uniform, so I cannot tell if our greeting police officer is fresh or not.

Like us, police personnel wear their rank on their shoulders. You can tell if a police officer, affectionately known as a 'cop', is senior or junior by the number of lines they wear on this part of their uniform. Ambos also wear rank, both clinical and management related. It helps to know the level of seniority in police and ambos at a glance. To wear certain rank, you need time in the job, experience and competence. A sense of relief comes with the presence of high-ranking clinical professionals on a job – there's relief in the presence of someone who knows what they're doing, and can take control and make good decisions.

On this particular day the epaulettes on my shoulders indicate I'm qualified to do this job unsupervised but I'm not senior by any stretch. I am not 'green' or new, but I am years away from earning the respected title of 'frog' – intensive care paramedic. It's a funny term, really, apparently used because 'everyone they touched croaked', but we use it as a term of great respect. Most of us hope to earn that title one day, and I am frequently in awe of the frogs I work alongside. They are always so calm and seem to know exactly what to do in every circumstance.

Rank or no rank, the cop is looking wide-eyed and neither he nor anyone else is doing anything to stop the woman from throwing pots over the balcony. They continue to smash and for a second I consider my helmet, which is still in the truck. How ridiculous that would look, but I still think about the vulnerability of my skull and I'm a bit pissed off that the cop isn't managing this crazy behaviour.

Do you think one of you guys could control that lady? I think, becoming a tad concerned about the increasing hysteria. This thought must be written all over my face as I gaze in the direction of the noise with a furrowed brow.

'That's the girlfriend,' the officer says, guiding us into the scene. 'She found him hanging in the stairwell inside. I think he's gone.'

At this point my mind tunes the screaming woman out of focus. Her emotions are spewing out all over the place, which is understandable, but if this guy needs us to work on him it's best if we're not distracted. The mind takes a single track: all we want is access to the patient.

The first thing I see as I walk though the apartment door is a cop with a notebook in hand looking relieved to see us. We're in a lounge room that has a lived-in feel, a little cluttered perhaps – these people are not from the upper end of the socioeconomic spectrum – but it's homely, and the officer looks out of place standing in the middle of the lounge room. There is carpet and a print of an eagle on the wall. The air isn't thick with cigarette smoke as in many public housing units, and there are DVDs piled up on the coffee table. Then I see him. Not hanging, but lying on the couch. He's not sleeping, though; he's most certainly dead.

At first glance my mind plays a trick and I think for a second he's been eating a blue snake. Maybe he vomited it up, or choked on this blue snake? A second later my mind corrects itself and I realise the snake I am seeing is his tongue. It's way too long and it's stuck, as if frozen, out of his mouth.

'He was hanging by his belt. The girlfriend cut him down and put him on the sofa here,' the officer informs us. It feels like awkward small talk loaded with expectation, and yet I'm already starting to feel out of my depth, like I don't quite know what to say.

'Um, righteo then,' I say, a little scared to touch the body but curious to know if it's cold.

This is not looking good, he is blue, cold, he looks dead, he has no movement, he must have been here a while, I think, as my brain moves out of treatment mode and into scene management. After what feels like ages but is probably only a few seconds I have my next thought: confirm the obvious and call it in on the radio. He's dead.

Even though everyone in the room suspects and even knows this guy is dead, they wait and watch the ambos go through the motions and say the words. We put the ECG leads on and press our record button on the Lifepak machine. We let the printer run off a strip of ECG paper. Out it comes: a perfectly flat line, absolutely nothing going on in the heart, just as we all suspected.

'Four-two-four, patient is deceased,' I say into the portable radio microphone that sits on my shoulder.

Up to this point it's all pretty much science. If we can get in there and out in less than ten minutes, the psyche doesn't seem to take in the horror. The uncontained emotions of the loved ones who found the body can almost bounce off us; we can acknowledge how tragic the job was, and move on to the next one relatively unscathed.

If, however, circumstances dictate that we stay longer on the scene, then another story begins to unfold. We learn about the characters involved in the tragedy; we learn the name of the departed and the names of the neighbours and we hear about how they met and who they are. It is no longer science, but a real-life story of which we are a part. It becomes our real-life story too.

I am still in the scientific phase, taking note of the fact this young man was in good shape and is wearing designer underwear. There is a very strange juxtaposition as his body lies on the couch: his lower half looks like a Calvin Klein model, but his head tells a very different story. His face, contorted in a freeze frame at the moment of death, is icy blue. He is lying here as I imagined he might do when kicking back with his girlfriend watching TV, but with his jarring blue tongue.

I lift my head as I again tune in to the sound of pots being thrown from the balcony. 'He's gone! I love him!' echoes around the buildings. Then in through the front door comes a woman, and I know instinctively this is his mother. There is something about her gaze and singleness of purpose that says this to me. She doesn't seem to notice anything at all accept his body on the couch.

Fuck, how am I going to say this? I think, as an electric shock of panic runs through me and hits my toes. I know it is my job to tell her: this man, her son, is dead. Sometimes people don't realise what is obvious to us, and need to be told quite directly that someone is deceased. It is never an easy conversation and I am already scratching my mind for the words.

She doesn't see the six police officers standing outside the apartment, and she doesn't see me, despite the fact I'm sitting right next to her son. She doesn't flinch at the sound of the pots smashing. She makes a direct line for the patient just as we did, only this is her son, her own flesh and blood, who lies here dead.

Hmm, we're stuck here for a while now, I think. The girlfriend is demented with grief and will probably need to be transported to hospital. Mum is going to need some support and an explanation. I wonder if she knows what happened.

Some ambos have the gift of the gab, and up until this very day I thought that included me. After a few years' experience I usually know what to say and how to say it. I thought I knew how to sound professional and polite yet caring and sensitive, and how to prepare a person for the procedures following a death. I thought I knew it all. Until this very moment, I thought I knew it all.

I had built walls around my heart and led with my head. Arrogant and self-assured, I had walked myself into a barren wasteland without knowing it, and my mental resources were now failing me utterly. I feel useless, paralysed.

The mother sits on a coffee table next to the sofa and faces her son. The sounds of pots shattering outside continues in stark contrast to Mum's quiet composure. It's confronting.

Um, should I say something here? I think. She does know he's dead, doesn't she? What the fuck do I say? Are they waiting for me to speak?

I exchange a glance with Belinda, who stares back at me and gives a quick shoulder shrug; she clearly has nothing to add. Apparently I'm not the only one feeling stuck. I want desperately to offer something but have nothing of worth. I have no words.

'Oh, my darling baby boy, I didn't know, I never knew. Honey, why didn't you tell me you were so depressed?' she asks him. She cradles his face in her loving arms and doesn't even flinch at his contorted expression, his stare into space. She doesn't seem to see any of that. She continues with her terribly beautiful monologue, and she is completely composed as she speaks to him.

'Darling, darling boy. My sweet boy, all you had to do was say something. How could I know you were so sad? My little angel darling boy, all the love in the world is here for you. I have always loved you, my sweet. I know things were tough last year, and I know you've been smoking, your mother knows everything about you. I've never stopped loving you, sweetheart. I never will stop loving you. Why didn't you let me know how much you were suffering, sweet, sweet, boy?'

She speaks with such tenderness, her mother's love completely unbound. I wish he were still alive to hear this. If only he were not so dead.

As for me, who only half an hour ago was remarking how 'cool' it was because we hadn't done a hanging in a while, I'm completely stumped. I sit on the coffee table with Mum right next me and I rest my hand on her back. I'm mute, her silent witness, deeply humbled in this moment. Now it is me who is frozen; for the first time in my life I have no words. Not a single word comes to me so I can't form even the simplest sentence to offer support. I'm shell-shocked; I have nothing.

As I sit frozen in this parent's worst nightmare, Mum starts singing a lullaby to her son.

'Day is done, gone the sun from the lake, from the hills, from the sky ... all is well, safely rest,' she sings. She caresses him and rocks him back and forth, and quietly, gently sings to him.

Oh my God, this is awful, should the cops get her details? Um, I should tell her there's nothing we can do. We tried. No, we didn't. Do I say 'I'm sorry'? Do I ask if he suffered from depression? Did anyone know? Do I speak now? Are they waiting for me? Why is nobody speaking?

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Excerpted from "Paramedic"
by .
Copyright © 2018 Sandy Macken.
Excerpted by permission of Rockpool Publishing Pty Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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