Monday, February 06, 2006

Professional Development

"See this, son?"

It was a rhetorical Fred Ventricle who spoke many years ago with the earnestly optimistic aspect of a benign schoolmaster addressing a favourite pupil for whom he harbours high hopes of future greatness as he fished from his tunic pocket and held up like a prized specimen to demonstrate for my edification a common or garden plastic carrier bag, well-used but still serviceable, of medium size and pale blue in colour, and bearing the legend Arding and Hobbs Clapham Junction emblazoned across both sides in bright red lettering. Taking quite seriously his new role as my guide and mentor, Professor Ventricle had become markedly didactic in my company and I was feeling increasingly like the greenest of raw pups at the knee of the Master, obliged to hang on his every utterance as I awaited the generous bestowal of his next pearl of arcane wisdom.

"D'y'know, son," the unremitting tutorial continued, "there's more fuckin' people've died in this fuckin' bag than on the fuckin' Titanic." The Mr. Chips analogy, having been driven headlong into an enormous mass of floating ice, descended prow first and came gracefully to rest upon the ocean floor.

I chuckled uncertainly, assuming he was either trying to be funny or had been struck down by a sudden bout of insanity, finally succumbing to the ever-present influence of the madness all around us, as though lunacy were an airborne contagion. Well, indeed, perhaps it is, and the theory has certainly been acquiring new levels of credence recently, but he turned out to be more or less as sane as I was at that time, and was simply being kind enough to take the trouble to introduce the new lad in his charge to one of the tools of our trade, and to another of the time-honoured practices of the ambulanceman's calling.

Back then, when I started on the ambulances, all training was done this way, on the job, and to be an ambulanceman required very little in the way of academic qualification; indeed, not even the crudest fundamentals of literacy were considered essential, as can be witnessed to this day by the memoranda generated by most of the older officers. As for me, I was taken on about two months before Fred's crewmate, George Ailment, was due to retire, and put to work alongside the pair of them, watching and learning and picking up what I could until George went off to spend his last days of freedom tinkering with his collection of electric kettles prior to his admission to the asylum to await the end, whereupon Fred took sole charge of my education and taught me, in his own inimitable style and to the best of his limited knowledge and dubious ability, the ancient and clandestine ways of the Chair and the Blanket. Right to the core I am - and believe me, I know it shows - Ventricle-trained; just as Fred himself was schooled in the craft by Herbert Ligament, who was in turn a product of the legendary Ebenezer Vein, whose seminal volume, The Modern System of Stretchering, continues to this day to inform the essence of ambulance work.

Thus are we able to trace our heritage back like a family tree to its deepest roots, to the very dawn of Ambulance Man, following its many twisted and perverse branches in a great variety of directions, which is why, in the old Clapham Ambulance, no two patients would ever have received the same form of treatment from two different ambulancemen. Now, of course, the loathsome homogenisation of healthcare is denying the poor patient even that small, life-affirming element of sporting chance, and I can't say that it's doing anyone any good.

Back then you learnt the ropes; today you are subjected to a process of continuous professional development, and every newly acquired accomplishment, however irrelevant or insignificant, must be documented and certificated to assist you in the process of career escalation.

Nowadays, in order to be allowed to perform even such an everyday and simple task as securing the binding mechanism of one's rigid-toed occupational foot and ankle protective outerwear, a practice sometimes referred to by the heretical colloquialism 'tying one's bootlaces', one is required to undertake a special course of training, the Health and Safety implications of the exercise having first been analysed in the minutest detail by the Operational Risk Assessment Working Party (Footwear Sub-Committee), and its application tested exhaustively in the field by the Special Ad Hoc Knotted Fastenings Research and Trials Unit, before gaining provisional approval by the Operational Equipment Working Party (Protective Clothing Sub-Committee), whose full report will be submitted to the Executive Uniform Strategy Team for final consideration and referral up to the Public Health Service Ambulance Training and Education Directorate who will eventually devolve responsibility for devising a course of study to the Clapham Ambulance Brigade Training and Professional Career Development Department, the head of which will refer the matter to Nobby Harris who, in reality, will probably just get one of the older lads to show everyone else how it should be done, following which every man, assuming he has pulled the laces to the requisite tension and tied the bow in the prescribed fashion, and signed the forms to say that he has not only done so but has fully understood and appreciated the philosophical implications of the procedure, will be presented with an officially embossed certificate to add proudly to his personal Portfolio of Clinical Achievement and Record of Skills Acquisition.

Back then, when Fred showed me his bag for the first time, we were standing over a sodden, malodorous bed upon which lay, propped up on a couple of squalid pillows, a stinking, wizened, and doubly incontinent crone by the name of Mary O'Dooley who was dribbling a creamy substance quite prodigiously from a gaping, toothless mouth down the front of a filthy nightgown. Fred explained the correct technique for taking a firm grasp of her wrists and wrapping her arms around herself, and instructed me in the correct manner of sitting across her legs to keep her steady while he placed the bag over her head and sealed and secured it with a homemade neck tourniquet, ingeniously fashioned from an old pair of braces. She struggled vigorously for a couple of minutes and then her head fell limply to her chest and she was still. Fred removed the bag and folded it with mock reverence, as if it were an authenticated napkin from the Last Supper, and with a theatrical wink replaced it in the breast pocket of his tunic. I wondered if he ever gave it a bit of a rinse-out, but decided quickly that such idle speculation was best dismissed swiftly from the mind.

"She's gone," he said with patently bogus sympathy when we were back downstairs. "I'm afraid there was nothing we could do." And I watched the deceased's son as he let out a long, articulate sigh, brimming with emotion and quite transparently restrained only by the rigid etiquette of bereavement from punching the air and dancing a jig around the furniture; and then he passed something furtively to Fred which was palmed and trousered with the practised dexterity of a stage magician; a card changed hands - Ventricle Bros. Economy Funeral Services - a few quiet words were exchanged, followed by a snatch of muted, mirthless laughter, and the O'Dooley family was left in peace to ponder both its terrible grief and the problem of how to spend its not inconsiderable inheritance.

Outside, in the privacy of the van, Fred handed me four five-pound notes and as we rolled cigarettes he continued my course of education in the facts of life in Ambulanceland.