This is a tiny book. A tiny red book. It’s described as a novella, but feels pleasingly like a monologue, or something in an oral tradition. As an object, I liked the book’s attention to detail: ‘Cover design and layout dedicated to Reclam, Universal Bibliothek’. Something ‘fuck you’ and something of the scholar. And there’s a playful comment by Stewart Home on the back, calling Takeaway 'a cynical low-life cocktail that will make you retch.’ Home is an artist, filmmaker, writer, pamphleteer, art historian, and activist, who has dedicated years to punching up counter-cultural activity, though he is best known for his novels such as the non-narrative 69 Things to Do with a Dead Princess (2002); also, you’ve got Ben Myers, award-winning author and one of the finest novelists working in Britain today, noting on the cover that ‘the depiction of ambulance life at the NHS frontline recalls Hogarth and Dickens in its depth and colour.’ Though Takeaway is a vivid, breathlessly done sketch and not a finely wrought artefact, we’re still not too far away from Gaffer Hexam in Our Mutual Friend, who makes his living plumbing the river for corpses, or the characters in Hogarth’s A Harlot’s Progress and A Rake’s Progress, or Beer Street and Gin Lane.

Some might find this book shocking in its descriptions of dying and depravity. I do not. This may be because I’ve learned quotidian dark humour (and deploy it in all my writings) because I was surrounded by out-and-out weirdness from an early age, plus illness of all sorts, terrible deaths, sectionings, disappearances and other unexplained events. So you cannot shock me, Tommy. Even if you are a renegade Hackney ambulance driver who takes us through his shifts and his colleagues; the people who tell lies and those who are genuinely in need; the old people who’d still give you a kicking if they could - because ‘Selfish cunts get old too’ - and the man who purportedly has a lightbulb up his bottom. (He doesn’t, though he cannot explain where it went.) Tommy ‘worked with one paramedic who had his finger bitten off by a Guardian journalist. If he was some Benefits Street type character . . . he’d get eighteen months, but I think they let him off with a fine.’ I laughed, then thought I shouldn’t: guilty pleasures; bitter aftertaste.

The book looks at how or why someone might call an ambulance to try and get rid of an elderly relative and what might happen to someone who is an alcoholic and has been found accommodation in an old people’s home; at the activities of someone entirely wasted who goes back to their corporate world on Monday morning. It made me think, all this. About what people do. I see spectacular kindness all around me, but I also saw distant relatives appear when a dear older alcoholic friend was desperately ill; so nice, they were that they inherited everything and threw all her cheaper (but treasured) possessions in a skip in front of those who really, truly loved her. And I’ve been a carer and also been in and out of Mental Health services and seen some shockers. And I liked Tommy because, although he skives and dives and copulates once in the back of the truck with a ‘Nurse Shipman’ while she performs erotic near asphyxiation, he is funny and aware of what’s kind, how you should look after your mother if she’s covered in shit and where it’s best to die. He was lazy and rude, but he was decent and knowledgeable, too.

There are startling sections on when you know, immediately, if someone is dead or not (‘. . . there was no . . . structure . . .’); there are particular streets where the ambulance is called and streets where they often attend, and the provenance of these patterns remains a mystery. This passage, previously published in Hotel magazine, is about ‘The Zone’:

‘We were physically in the same borough of London, but we clearly had such radically different perceptions of the world that we were barely inhabiting the same place at all. We were in two different zones that overlapped geographically, but not psychologically . . . my crewmate and I spend more time in the zone than we do in our own lives . . . to show you the madness that goes on in this other zone, they reckon about a hundred people in London account for something like fifty percent of all the ambulance callouts. It’s like they want a gold membership card, or a special closeness with their god, the fear of death.’

Tommy wonders whether people think that if they cheat the NHS, they might cheat death; it is a weird but fascinating scenario. People are pathetic but also understandable when they come up against eschatological stuff. Though the book does not stint on somatic or psychosomatic symptoms, these are not belittled but approached practically, like Mr P’s fits on demand. The author is not mocking, although he does give short shrift to those who are too thick to grasp what’s going on. Neither does the text stint on suicide and its modes, sex, mental illness or other people’s cruelty. It shouldn’t have been funny that one Welsh lad had ‘Land of my Fathers’ on a loop, but I’ve learned to laugh in the oddest places.

Humour, even in its darkest reaches, is coping and a corollary of love and compassion. Irreverent, appalling, insensitive humour can be a form of generosity if it’s shared. There was one final scene best described as arresting and which I am sure plenty of people would find offensive. However, having seen a badly managed death which involved sheer terror for all, I might have a different insight here. There’s an ‘old girl’ who’s decided to die at home:

'"You mum has decided to die at home," I said. "We should respect her wishes."
Because they want so badly to get her into hospital, they start making things up. Absurd things. Cruel things, about her spiritual belief and cognitive abilities.’

When the specialist nurse arrives, it’s a freshening air in a murky little flat and she wastes no time in making the old girl comfortable, propping her up with two pillows and popping her chin onto her chest:

‘. . . we’d never seen such empathy.
The nurse had suffocated her.’

There follows an extraordinary scene in the back of the ambulance with this nurse and ‘I guide her cold, white hands over my throat.’ Tommy has both some musings on the erotic and that ‘this mass of crippled souls needs euthanasia nurses more than it needs a mayor’. We are awake to unpalatable suffering here; that not everyone is cared for; that there isn’t always love or appropriate resource and that Eros and Thanatos hold hands.

Have a read; a quick read. A joke and a drink. There are shades of the Dickens and Hogarth, yes perhaps, but remember Denis Johnson, whose Jesus' Son is quoted as preface: 'What I write about,' Denis Johnson once said, 'is the dilemma of living in a fallen world, and asking why it is like this if there's supposed to be a god.'

Anna Vaught is a novelist, poet, editor, and reviewer, and also a secondary English teacher, mentor to young people, mental health campaigner and mum to a large brood. She tweets as @bookwormvaught.

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