In a rare coincidence, three separate teams have arrived at Lily’s house at the same time: carers, occupational therapists and me, the assistant practitioner. It’s a small house, barely room for Lily, her husband Denis and her son, John, let alone five other people, each with their bags of equipment. The OTs have even got a bed-rail to be fitted.
‘Who else is coming? The army?’
‘Yep. But don’t worry. They’re lowering themselves down from a helicopter.’
‘Oh. I see.’
Lily lives right on the western fringe of our area. I’m guessing that everyone’s made the same calculation: do the furthest one first. Consequently, none of us is in a position to say I’ll come back later. We’re all on a tight schedule. It’s now or never.
We work round each other. It’s like one of those puzzles where you have to think three moves in advance of the move you want for yourself. We stash bags strategically, move furniture, hand each other things if we happen to be near them, the whole thing like an improvised game of Twister. Lily’s husband has dementia. He gets moved from seat to seat (along with the seat), each time landing placidly and looking over the whole mess with a wintery blue vacancy.
‘Are you going to be long?’ says the son, John. ‘Only I’ve got things to do.’
Despite our reassurances, Lily is getting more distressed. She hasn’t long been out of hospital. Getting discharged must have been a huge relief, but now it must seem as if the hospital has simply followed her home.
‘Now – I just need to do a quick ECG,’ I tell her. ‘Could we clear the room for a moment whilst I stick on the dots?’
Everyone but Denis finds a route out. He sits on his seat, watching, his stick planted in front of him.
‘And the last dot goes round…here. Thank you. Now then. Let’s see how it’s looking.’
‘Wobbly,’ she says, and glancing over at Denis, she takes a deep, sad breath.
That first appointment sets the tenor of the day. I race around town, fighting to cover all my appointments, struggling to get my head round the complexities of each case, the social aspects, medication regimes, observations and their significance, writing up my notes, figuring out what each patient needs.
Back at the hospital, it’s obvious everyone’s had a similar day. We’re coming in like bees to a hive, doing our little dances, handing over intelligence.
The co-ordinator for our team looks unhappy. He doesn’t meet my eye when I go through my patients. The stress of his position inevitably means he has to strip each patient down to the bare facts: NEWS score (the higher the score, the sicker the patient); whether you did what you were down to do; can they be discharged?
‘The ECG didn’t show anything new. AF, that’s it.’
‘Did you take the ECG to the surgery?’
‘No. There wasn’t anything acute.’
‘You’re supposed to take ECGs to the surgery.’
‘Well. Okay. I didn’t know that.’
‘No-one told you?’
He shakes his head. Jabs a note onto the database.
‘If there had been acute changes I would’ve taken it round,’ I say.
‘That doesn’t matter,’ he says, leaning back in his chair, still not looking at me. ‘You’re not a doctor. You’re not supposed to interpret these things. If Lily dies it’ll be your fault.’
‘Fine!’ I say, flaring. ‘Put me down for Lily’s death. And if you have a heart attack going home tonight, put me down for that, too, because maybe I was the last one to talk to you.’
‘It’s a responsibility,’ he says. ‘You’re supposed to take ECGs to the doctor. That’s it.’
‘So what am I? Just someone who carries stuff around?’
‘If something happens…’
I finish handing over my patients, glacially polite.
Gather my papers together and go to the folders cabinet to file them away.
Ellen the pharmacist comes over and asks if I want a cup of tea.
‘That would be absolutely wonderful.’
‘How do you take it?’ she says, then smiles warmly. ‘The tea, I mean.’