The Gap

I came across The Gap recently while browsing the new releases on one of my library e-audibook apps. I hadn't heard of it, or the author (or so I thought) but borrowed it immediately and was soon listening to it in the car and out on walks with the dog. 

The Gap of the title refers to a beautiful clifftop on the South Head of Sydney Harbour. It offers a wonderful view, and a lovely sea breeze. But it has long been a busy spot for those wishing to end their lives. And so it was in the Sydney Summer of 2007-8 when Benjamin Gilmour was an ambulance paramedic stationed at Bondi, Sydney's most famous beach, a short drive south from The Gap. 

At the highest point of the The Gap where the clifftop rises like a tower it is 90 metres to the sea. Tourists and day-trippers come in groups to stand at the wood and wire fence inhaling the sunrise. They chatter about nothing of consequence but are quickly made speechless by nature's might. I've seen them stand like people at a crossroads, suddenly conscious of their smallness. The Gap is a place of great change, new journeys, different paths but for others who come their hope is long lost. To them The Gap is a backdrop for the final act of life. It's the edge of the world from which they leave. Fifity or more go over each year from the top or further around where the fence is easier to scale. They do it at dawn, in the heaviest rain and on the quietest of nights. For us local paramedics the beauty up here is hard to admire.

The Gap was written at the time, but Benjamin Gilmour thought it was too sensitive to publish at the time, and it is only with the passage of time that he feels these stories can be told. I did wonder at the rather strong trigger warnings in the Introduction, about mental health, black humour and the need for it for emergency services workers at all levels. Having read the book I can fully understand it. 

What will never change is the trauma and death that paramedics are exposed to and the impact this can have on us and the way we manage our mental health. 

The manuscript was even assessed by psychologists, and changes made to soften imagery and remove explicit detail. At the beginning I was dismissive about this, but then I listened to the book. It's by no means soft or warm and fuzzy. There is a lot of death, a lot of it by suicide, but also trauma, heart attacks and other medical conditions. Benjamin Gilmour and his partner have a bad run of calls, and come to refer to their ambulance as the Suicide Truck, and feel that he is a Suicide Magnet. All while Gilmour and his (ambulance) partner John are going through the breakdown of their own personal relationships.

Gilmour is an author and filmmaker and he doesn't just write about a series of jobs he has attended as an ambo in Sydney, he takes a longer lens to look at his patients and their lives. 

As we leave the building I contemplate the lives that have ended here. The building is a repository of worn-out men and women with deeply tragic stories. Lives spoiled by drugs and alcohol, marriage breakups and mental illness.

It is not a cheery, postcard touristy version of Sydney that emerges from these pages. The Gap takes a long hard look at the very detrimental effects of shift work and sleep deprivation on ambos, who have a challenging job to begin with. Traumatic shared experiences at work creates close bonds among paramedics and other emergency services personnel. These experiences also take a great toll on the health and well being of those who respond to these calls. But they have great resilience, showing up for shifts when they can be hurting more than the people who have called them for help.

The cases are banal, but as soon as I'm chatting to my patients I'm in their lives and not in mine, and that's what I'm here for. 

At the time of writing most of the book Gilmour had not had a patient suffering an out of hospital cardiac arrest survive to hospital discharge. Not uncommon. In the introduction he says that has changed in the decade since, with better bystander CPR, and public access to defibrillators, that he has had some saves. Still survival of out of hospital cardiac arrest is around 10% in Australia.

"We tried our best, but he didn't pull through". It's a worn phrase that makes it sound like it's the old man's fault, as if he refused to come back. "We tried our best" sounds inadequate too. It may be true that we tried our best, but I wonder if trying is good enough. In our line of work where the opposite of success is death there's no prize for trying. 

Hmm, yes, but these people are already dead. There were several sections where Gilmour talked about the words we use at times like this. I have to speak to people frequently at these times in my own job, and I enjoyed his thoughts and perspective on the words we use. These are difficult times, for everyone. The ambos, the families and loved ones. Gilmour's partner John used to tell suicidal people that you don't have to kill yourself to get people to listen. I like that phrase.

I listened to the last third of the book in one afternoon. I hadn't intended to. I planned to listen for an hour or so while I was doing some weeding, but was unable to stop. I had tears streaming down my face for much of that last section. I finished off the remains of a bottle of red that night, and then had an extra glass for good measure. I had been planning to start watching Unbelievable that evening, but I chose a couple of episodes of Black Books instead as some much needed relief. 

Matty Morris did a sterling job of the audio narration, coping well with all the medical terms that necessarily lace a paramedic memoir. But I wish someone had given this poor Melbourne lad some help with the pronunciation of Sydney place names - Clovelly, Cahill Expressway, Vaucluse and more. In a book where the Eastern Suburbs Sydney location was such a major part of the story it would have been nice.

Benjamin Gilmour RN Lifematters interview