Two minutes and thirty-five seconds and not a word exchanged between medic and patient.
‘Did you know her?’ I ask, perplexed.
‘Not personally,’ says Dr Aquarius, climbing back into the ambulance.
‘How did you guess what was wrong with her? Or what to give her?’
‘You should understand by now. When they want an injection straight up it’s the same thing every time. Vitamin B1, B6, B12 and C for good measure.’
If they’re agitated, Valium is part of the cocktail too. And gypsies are notoriously prone to agitation. Should the Valium run out, the doctor will resort to aqua injections – plain water or normal saline. Few patients know any better. It is not about the drug anyway but about the spritz. With the exception of heroin addicts I’ve never met a patient enthusiastic about injections. Many Roma, however, can’t get enough. This is because they have what Dr Aquarius calls ‘injection jealousy’. Should a gypsy observe her neighbour receiving two vitamin injections from an ambulance crew, she will later call up and try to outdo her rival by asking for three. Roma are very jealous people. Angry scenes occur if ambulance crews don’t give the maximum number of injections, regardless of whether the patient needs them or not.
‘Once, in Shutka alone, I gave one hundred and thirty injections over a single week,’ boasts Snezhana Spazovska through the slide window.
Seems to me a bad precedent has been set. A community expectation has been established from which these medics find it difficult to escape.
‘Most of the time the Rom are very peaceful,’ says Dr Aquarius. ‘But, well, we give as many injections of Valium or vitamins or aqua as it takes us to get out of there quickly. It is not only Rom. Other Macedonians are like this too. No patient in our country is satisfied without a spritz.’
Injections are a matter of service efficiency rather than pandering. If a crew decides to leave without giving a jab, the patient is likely to wait fifteen minutes or so then call again. Indeed, they will call and call until they get an ambulance crew willing to give them one. Repeat callers are not unique to Macedonia and are a problem anywhere, in any country. Some callers in Australia are known to have our easy-to-remember three-digit emergency number on speed dial. In exasperation, some paramedics manage this problem by transporting the patient to hospital to remove them from their home phones so they won’t call again. Of course, this simply shifts the problem. Treating patients in the field is more desirable, but whether it is ethical to inject a patient for the sake of operational efficiency alone is an interesting question. Maybe a little bending of the rules is justified for the greater good, allowing ambulances to be more readily available for life-threatening cases. I can’t help thinking, however, that if injection-jealous gypsies knew that the party was over, the call volume would drop and the burden would ease naturally.
Girls with gold hoop earrings smile and wave and kick up bright floral dresses as we pass them trailing a mob of grubby children. Their look is a welcome flashback to the gypsy aesthetic of old in a township where most of the women have long ago discovered Adidas and cheap bling.
We pull up outside a peppermint-green house with a waterfall feature built against the front wall. Inside a middle-aged woman lies theatrically collapsed on the hallway carpet, hyperventilating. A dozen family members and relatives shuffle in behind us to have a look.
Dr Aquarius asks the woman a few questions, which she answers with excessive gasping and groaning and rolling about. Spazovska is next to me and whispers, ‘Pain all over.’
Right. Pain all over. As if I couldn’t have picked it, that classic ailment of the chronic neurotic. How it makes us laugh when we hear it! Not in front of the patient – never in front of the patient. Oh, but how we laugh. From what I can tell, Dr Aquarius is examining the patient in the same manner I do in such cases. Slowly she palpates every region of the woman’s body. What about here? And what about here? And here? And every time the woman groans or winces or pulls away, even when Dr Aquarius has reached and squeezed the tip of her pinky finger. What drives an unusually thorough examination like this is a hope that our looks of confusion in response to the patient’s unspecific complaints will be a hint to her and her relatives that we are not convinced and that perhaps, to avoid embarrassment, someone should put an end to the entertainment before we are forced to do so in the back of the ambulance.
‘She requesting something special,’ Spazovska says.
Gypsies love a bit of drama. This I can appreciate – life is great when it’s thrilling. Less forgivable are the patients who have an ambulance called for the sake of attracting attention. Attention-seeking exists in every country and in every cultural group, and is particularly prevalent in very large families. A person feeling left out or snubbed for some reason may decide that by feigning a medical emergency they will get what they crave. The strategy usually works well and they soon find their extended family standing around them saying pointless things like, ‘Oh my God! Oh my God! Oh my God!’ and rushing wet towels from the bathroom. Perfect! So long as their symptoms are as ambiguous as ‘pain all over’ and appear severe enough, the little fakers may even get a ride to hospital. Of course, on arrival they will make a miraculous recovery and discharge themselves before a doctor has even seen them.
Because these are delicate situations I wait out the front of the house. From where I stand I can see a ten-metre cherry tree belonging to a regular emphysema patient. A week ago I was up that tree picking cherries for her as she’d complained about being too old and breathless to climb a ladder. After that day Kass and I ate cherries for breakfast, lunch and dinner.
The adult daughter of the drama queen comes out and forces a cigarette between my lips. Her smile reveals a big gold tooth flashing in the sun. She wears yellow lycra leggings and a decorative red belt with a playboy bunny buckle. After she lights my cigarette she puts her hand on my shoulder and comes very near.
‘You are married?’ she asks directly.
I nod.
‘Not matter for me,’ she purrs, exhaling smoke in my face.
With a daughter like this it’s no wonder the patient has pain all over, I think. What kind of woman tries seducing the medic while her mother is near death?
From inside the house comes the sound of yelling. Something crashes and breaks. This is followed by a short scream after which Dr Aquarius saunters out, peels off her gloves and gives a wink.
‘She not wishes to come with us,’ says the doctor.
Sometimes it seems the crew is more effective when their international guest is not in the room.
Intense verbal exchanges are the norm in Macedonia. What sounds like an argument may be just as likely the whispering of lovers elsewhere. Macedonians, like Italians, Greeks and Arabs, for that matter, can have a simple interaction about the weather while sounding like they’re about to strangle each other.
An exchange like this occurred during one of my many meetings with ambulance service director Maja Poposka. The afternoon started badly when she showed me a video clip of a major incident exercise on a highway near the Serbian border. The footage had been set to a heart-wrenching song, Game Without Limits by Tose Proeski, a young Macedonian singer recently killed in a car accident. His death had been traumatic for the entire country.
‘I chose this song because I like it very much,’ Poposka tells me, looking off into the middle distance, just holding back her tears. ‘Sometimes in our profession we also push the limits.’
There is so much she could have meant by this, but I sensed she was referring to the risks, both physical and mental, that ambulance workers subject themselves to. Surrounded by craziness, by things going wrong, by lives twisted up, we risk losing perspective on our own reality. If this happens, anything is possible in terms of our personal behaviour. If we lose our grasp on rational thought our work may indeed become a game without limits.
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