the NHS arcana

In an average day I’ll see six or seven patients. Sometimes the contrast between their situations is so striking it’s like I’m dealing cards from an NHS-themed tarot pack: The Wronged Man. The Fool. Fortitude. King of Catheters. Death.

For example, my first patient: The Sofa.

It’s not only Stanley’s bloods that are deranged. The carpet is covered with discarded newspapers, letters, flyers, menus, books, crisp packets, remote controls, glasses and a hundred other things. At the heart of it all is the sofa where Stanley has been sleeping and living the past few months, the uncovered duvet thrown back, pillows yellowing, the whole thing looking like a burst artillery shell of loneliness.

Stanley has chronic kidney disease, diabetes. The renal unit call him in once a month to review his bloods. He’s at that liminal stage where the slightest movement south on his U&Es will mean he has to start dialysis. For now, he’s getting by the best he can at home. Getting a taxi to take him shopping, occasionally, although that’s been impossible the last week or so (as the pile of empty microwave meal containers in the sink testifies). Beyond his usual ill health, it’s hard to establish what’s acutely different, though. His bloods are poor, but nothing more than normal.
‘I just feel so exhausted all the time,’ he says.
‘Is there anyone around who could help out?’ I ask him. ‘Family, friends…?’
‘No. There’s no-one.’
Our job as the Rapid Response team is to get him back to something approximating normal. A guy to come in and clean the place up. Carers to do his shopping, make his meals and help him with washing and dressing. A Mental Health nurse to assess his state of mind. A pharmacist to review his obs. OTs to put in equipment. Physios for an exercise regime. Nurses to review his obs and liaise with the GP. We’ll do the best we can, but sometimes it’s overwhelming. Stanley didn’t end up like this in a matter of days or weeks. The breakdown in social connection often takes years to work its way out like this, into these extremes of social isolation.
‘What do you need from the shop?’ I ask him.
He gives me a list, and a ten pound note.

And then on to the second patient. Queen of Trolleys.

I haven’t been here before. A lovely block of flats, immaculate gardens, and the kind of residents who seem comfortable saying hello.
I’ve come to see Agnes. It’s a very temporary referral. The only reason she’s on our books is because of some strange, unanticipated failure in her care package. I don’t know the ins and outs, but I don’t get the feeling we’ll be coming in long.
Getting access to Agnes’ front door is a major intelligence test. In the end I have to call Agnes’ daughter, who explains that I have to retrieve a key from the lintel in the hallway, use that to open a service door, and then locate and open a keysafe.
‘All right?’ she says. ‘Found it?’
‘Yep! Thanks very much.’
‘Call me if you need anything else. And thank you for stopping by today.’
I let myself in.
A welcoming, meticulously tidy flat.
Agnes is in the living room, watching Loose Women. They’re sharing their wedding experiences, which Agnes watches with an open mouth. Her wedding photo is just by her on the bookshelf, but it’s not something she acknowledges.
I’m there to make her something to eat. Everything’s laid out – the ready meal, the dessert, instructions on how to use the microwave – in fact, carefully written instructions taped on just about everything, from the front door to the fridge and cooker. The butler sink has a scrubbed look, with a laundered tea towel draped on a rail and a selection of cutlery laid out in neat lines.
Whilst I’m waiting for the cottage pie to turn through its minutes, Agnes appears at the doorway, pushing her kitchen trolley. On the trolley is a little knitted bear, a remote control, and a box of tissues.
‘Are you all right, Agnes? What can I get you?’
She stares at me for a moment, then makes an approximate kind of smile.

‘Oh – nothing. Nothing, really.’
‘Lunch is almost ready. Would you like a cup of tea with it?’queen of trolleys

‘That would be … erm… yes. Yes, please.’
She turns and heads back to her seat.

Back out in my car, I write down the time, cross through Agnes, locate the next call.
I turn the wheel, and move off.

I flip the card.

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