Posted by: Lisa Hill | September 15, 2020

The Application of Pressure (2020), by Rachael Mead

I hesitated over buying this book.  I never watch those reality programs about first responders such as paramedics, not because I’m squeamish, but because I’d rather not wallow in the sordid side of life.  (I don’t read or watch True Crime for the same reason).  But Rachael Mead’s debut novel about the lives of paramedics cut through those reservations, not least because of the blurbers recommending it: Pip Williams, Peter Goldsworthy and Steven Armstrong among them.

Early in the book, the twin meanings of the title become clear:

Back in training, they learned a couple of ways to work out if someone is truly dead to the world or if they’re faking.  One is to rub knuckles really hard against their sternum.  It’s not pleasant.  The other is to press a pen into the bed of a nail cuticle.  This is equally unpopular.  Both the sternum rub and a nail-bed press will make anyone  who’s conscious flinch, even if they’re determined — for whatever bizarre reason — to play possum.  (p.14)

(Why anyone would do that, becomes clear as the novel continues).

Along with doing CPR to restore a beating heart, ambos (who we learn must never be called ‘ambulance drivers’ because they are much more than that) apply pressure to various parts of the body, but they are also subject to intense pressure themselves.

This is the blurb:

For paramedics Tash and Joel, a regular workday is like a supercut of the worst days of other people’s lives. They maintain their sanity through a friendship built on black humour, but as the constant exposure to trauma takes its toll, both, in different ways, must fight to preserve their mental health and relationships – even with one another. How much pressure can they handle, and what will happen when they finally crack?

With each chapter revolving around an emergency — some frightening, some moving, some simply funny — Rachael Mead digs beneath the surface of gore and grit to lay bare the humanity of emergency services personnel and their patients. This breathtaking novel reveals not only the trauma of a life lived on the front line of medicine, but also the essential, binding friendships that make such a life possible.

The novel is episodic, alternating Joel and Tash’s experiences (supplemented by narratives from some of the other ambos), from the early days filled with hope and fear, over twenty years to trauma, disillusionment and determination to carry on.  Some of the episodes are very graphic, (there are no joyful baby births) but there is an authenticity about the story that derives from the author’s marriage to a paramedic. From the claustrophobic home of a hoarder to the South Sudanese extended family who subvert expectations in a McMansion, the range of incidents is both depressing and uplifting.  There are moments of tense drama too when the ambos are attacked and have to deal with the danger on their own until the police arrive.

An impressive variety of obscenities come screaming at them down the length of the dark hallway.

Joel is still collecting himself outside the bathroom when the house falls silent — but for the sinister sound of a cutlery drawer being wrenched open.

The light spilling through the bathroom door into the passageway is just enough for Joel and Tash to make out Lucy’s slight figure sprinting from the kitchen into the hall, a carving knife brandished overhead.

‘Run!’ Tash drops the kit.  Adrenaline and instinct take over.  They bolt for the front door, Tash slightly ahead.

In theory, Joel knows there is a small orange duress button on his radio that automatically calls for urgent police attendance.  In practice, he’s damned if he can find the bloody thing in the dark while running full-pelt for the ambulance with a knife-wielding psychopath at his heels.  (p.15)

The cumulative effect of incidents like this bring challenges to their relationships, but the author has wisely resisted the temptation to segue a friendship of many years into a love story.  The dialogue between these two is laced with dark humour, and there’s a witty chapter in which Tash and Reuben, (replacing Joel who’s on leave) try to get as far through the shift as possible talking only in film quotes…

… but over the past few months, she’s seemed preoccupied.  Like tonight, I hit her with ‘Hope for the best, plan for the worst’ from The Bourne Ultimatum as we saddled up for the first job and I got nothing, just a tight-lipped smile.  I know for a fact she loves the Bourne films because she stumped me one of the first times we played this with ‘What’s the French word for ‘stakeout’ from The Bourne Identity while we were waiting in the ambulance for some takeaway… (p.212)

(I’ve never seen the film, but I’m guessing this is a play on words based on the American ‘take-out’ for ‘takeaway’?)

There is a strong sense of place for those familiar with Adelaide and the surrounding hills, and I liked the inclusion of a gay ambo as just one of the staff.

This is a compelling debut novel.  I couldn’t put it down.

Author: Rachael Mead
Title: The Application of Pressure
Publisher: Affirm Press, 2020
ISBN: 9781925972634, pbk., 280 pages
Source: Personal library, purchased from Benn’s Books Bentleigh $29.99

Available from Fishpond: The Application of Pressure or your favourite indie bookshop.


  1. I’ve just recently downloaded this on audible. I look forward to listening to it after your review. I’ve always been interested in hearing about various jobs people do and ambos are everywhere. Makes me curious.

    Liked by 1 person

    • I must say they are definitely in the category of health heroes: this book was obviously written before the pandemic, but reading it, I was acutely aware of the courage it must take to go to work each day when the risks are so high.


  2. Yes, I’m with you Pam. I’m interested in different jobs, different lives, even fictional versions. I heard about this novel somewhere – might have been some online book event I attended – and thought it sounded interesting. Glad to see your review Lisa.

    I don’t think I’d see a book about paramedics as wallowing in the sordid side of life – though no doubt some of what they attend is sordid. Not all of it is though?


    • Oh no, no it’s not. But there is a slight tendency to show us the sordid, as if to say, look, this is what it’s *really* like. There are two chapters which were particularly unpleasant… and you know, the author is a poet so her writing is *very* vivid… and now I have scenes visualised from the novel in my brain that I’d just as soon forget.
      I wish I had the kind of brain that can rattle off quotations from my reading like some people can, instead of which I have a library of vivid images from the books I’ve read: blood-soaked battle scenes from Tolstoy; women struggling through windswept vales from Thomas Hardy; arid streetscapes from Thea Astley and a man drowning in a river from Richard Flanagan.
      BTW his new novel is out soon, I have mine on order from Readings *happy dance*.


      • I wish I could remember quotes too, but I only have a handful. I don’t really keep images in my brain either though. I don’t think I’m a visual reader. What I most remember about books is feelings … how I felt when I read it. This got me in my heart or in the pit of my stomach or my brain, but I don’t remember the specific details necessarily that got me there, other than the general idea.


        • Yes, I have that too, and I also have vivid images of the characters. I remember the first time I saw a book-to-screen adaptation and was so shocked by the difference in how I’d imagined a character and how they’d cast her, that I actually got the book out to find out if it were they or I who had got it wrong.
          That is why I can’t bear modern adaptations… they all have beautiful teeth, because actors do, of course, and it looks ridiculous for historical fiction and adaptations of classics, especially for Dickens who wrote about the poor. Fagin, with a perfect set of teeth? I don’t think so.

          Liked by 1 person

  3. I confess I think this isn’t for me – I really don’t do the gruesome and realistic as a rule!


    • One day when they’re writing the history of literature and the continuing development of the novel in Australia, I think they’re going to write that in the C21st the long tradition of Australian realism has continued, alongside the use of dystopia to reveal discomfiting aspects of our society. And they’re going to need some of our fine red wines to fortify themselves as they read them all.

      Liked by 1 person

  4. I think after a lifetime of working in hospitals this novel would be in all too familiar territory for me!
    My concentration seems to be getting worse – a book has to be very, very good to keep my interest for long these days, and almost everyone I speak to is having the same problem. I can’t even watch a movie it has to be something short and pithy! I wonder if others here are finding this?


    • Too close to the bone!
      LOL I don’t want to read books about schoolteachers either… I got a little bit tired of Thea Astley dragging them into so many of her books.


      • She was taking the advice write about what you know too much to heart?
        From what they’re saying in today’s SMH about teachers who are unable to teach writing, I wish we had more Astleys around in our schools!


        • I think it was one of the things she was bitter about and so it cropped up in her writing again and again, the teacher isolated even among colleagues because (it seems) she despised them because they were not her intellectual equals and they didn’t understand her.


          • Yes she identified very strongly with the outsider Lisa – my brother was sent to a small, very isolated (by desert) outback town when he finished his teaching degree and found it incredibly lonely – my parents managed to get him back to the city early due to mental health problems – the local people did not like someone from a sandstone university and he also didn’t know how to connect with them. It was a very tough gig for a newly qualified teacher and he had nobody in the town who shared his interests.


            • I don’t doubt that she spoke for many and that her experiences were widespread. But (possibly because I read four Astleys in a row with nothing in between) I did see the same trope again and again.
              BTW I found a copy of Reaching Tin River at Brotherhood Books *happy dance*


  5. […] reviewed the non fiction book The Application of Pressure. You can see her review here. I was interested in this book after reading her review. As I had a credit on my […]


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