The signs were clear from the start.

The house of the first patient turned out to be a hostel for independent living, divided into flats. I tried number one, no answer. Then two, three, four…. no-one, and no on-site staff. I rang the patient’s mobile – out of commission. I rang Claire in admin back on base – permanently engaged, except for a couple of times when I was put through and then immediately cut off. I rang the source of the referral, a street-sleepers facility, who gave me five alternative mobile phone numbers. I tried them all. None of them worked. I phoned Claire again (and got through, incredibly).
‘I give up. I’ve tried everything but a Ouija board to get in touch with this guy. We’re going to need some better information.’
‘I’m not surprised,’ says Claire, sounding exhausted. I can picture her, the phone cradled to her ear, whilst people come and go through the cubicle, all of them stressed and wanting something, whilst she writes out a memo and reads an email at the same time. ‘Last time he was on the books I think we caught up with him once.’

So I’m looking forward to the next patient. It’s been given to me on the fly. Would you mind swinging by to see Rachel, an eighty-four year old female with a query UTI? If you could do a quick set of obs and a urine dip, that’d be great.
It’s a smart block of flats I’ve been to before. Easy parking under a shady tree, so the car won’t be quite such a sweat box when I come back. It all looks good. The stress of the morning already feels easier.

I go to the main door. There are a dozen key safes clinging to the wall in a group like mussels on a rock at low tide. I have the code for one of them. Sometimes these things are marked with a dab of nail varnish or a piece of coloured tape to help you go straight to it, but I don’t mind. I start at the top and work my way down.
None of them open.
I put my bag and book down and try again. Same result. I try buzzing the flat directly. Sometimes there’s a relative on scene, sometimes the patient can actually get to the door.
After a while, Rachel answers.
‘Hello. My name’s Jim. I’m from the Rapid Response Team at the hospital. I’ve come to see Rachel McGoogan.’
Well I’m Rachel McGoogan! What is it that you want?
‘I’ve come to do your blood pressure and so on. To see how you are.’
To see how I am?
Who did you say sent you?
‘The doctor.’
What doctor?
(I suddenly realise I don’t have that information, so I try to wing it).
Your doctor.’
And who is that?
‘I’m sorry but I don’t know.’
Are you sure you have the right place?
‘Yes. Absolutely.’
I’m not sure you do.
‘Yes. Absolutely. Rachel McGoogan. Beech Apartments. Flat Seventeen.’
Well that’s me!
And what did you say you’ve come for?
‘To see how you are.’
I’m fine thank you. Good day.
She clicks off.
It suddenly occurs to me it might still be early enough to use the tradesman’s button. I press it. The door opens. I grab my bag and go up.

I knock on her flat door and ring the bell. There’s no reply. I peer through the letterbox. It’s all quiet.
‘Rachel? Hello-oo. It’s Jim, from the Rapid Response Team. Is it all right if you came to the door for a chat?’
No response.
I check my book and find her telephone number. The phone rings – at immense volume – just the other side of the door. When eventually she picks it up, I can hear her voice more clearly through the door than through my phone.
Rachel McGoogan.
‘Hello, Rachel. It’s Jim, from downstairs.’
Downstairs? What do you mean, downstairs?
‘The front door. From the Rapid Response Team.’
What do you want?
‘I’ve been sent to check your blood pressure and so on, to make sure you’re okay.’
Of course I’m okay. What on earth do you mean?
‘You haven’t been well lately.’
Haven’t been well?
‘You’ve had an infection. I’d really rather talk about it face to face.’
I don’t understand what you’re trying to say.
‘The doctor has asked us to come round for a few days to make sure you’re okay.’
If I’m unwell, I’ll go to the doctor. I haven’t the faintest idea what you’re talking about.
She hangs up. I can hear her walking away, muttering.

I go back downstairs. Given her recent history, I know I’ll have to make more of an effort to see her, so the next step is to find out what the actual key safe number is. I try ringing Claire again, unsuccessfully. Then I try the care agency. The person who answers the phone has a stammer, so bad it’s virtually impossible to understand anything they say. I give them my number to phone me back once they’ve checked the records.

I sit down on a low wall to collect myself.

I look around, at the trees, at two guys up on a roof, working. They’ve taken their t-shirts off and wrapped them round their heads. Oh my god,  I think. It could actually be worse. When I look down again I notice that there are two key safes the other side of the wall. I try them. The top one’s Rachel’s. As I’m letting myself in the main door again, the guy from the care agency rings back. The key safes were round the other side  I tell him. He starts trying to say something beginning with N, but I’m too impatient to let him finish. I thank him for his help, then making the excuse that the lift had just arrived, hang up. As I ride up to Rachel’s flat, I think about the wisdom of putting someone with such a pronounced speech impediment on the help line – and then immediately feel guilty that I should be so uncharitable. Is it any wonder the day’s so jinxed?

I arrive back at Rachel’s door and announcing myself as cheerfully as I can, let myself in.

She’s sitting in a high-backed armchair in full sunshine, her fingers laced contentedly across her tummy, one leg crossed over the other, the foot tapping up and down, like she’d been expecting me all this time.
‘And who might you be?’ she says.
‘Hello! Rachel! I’m Jim, from the Rapid Response Team. We spoke on the phone.’
‘The chap at the door?’
‘Yes. And the door. That’s me.’
‘How on earth did you get in?’
‘I used the key safe.’
‘What d’you mean, key safe?’
‘A safe. On the wall. For keys.’
‘Whatever for?’
‘So people can get in and out.’
‘What people?’
‘Carers, district nurses, paramedics – in an emergency.’
‘But why would I want all these people in my flat?’
She leans forwards.
Who did you say you were?’ she says.
‘Jim. From the Rapid Response Team. Would you mind if I had a quick look at your yellow folder?’
‘Whatever for?’
‘To see how you’ve been over the last few days.’
‘I’ve been fine! How extraordinary! I must say I’ve never been spoken to like this before…’
I flip through the folder to get some more information.  There’s no mention in her past medical history of dementia or short term memory loss.
‘Well?’ she says.
‘I’ve been asked to check your blood pressure and temperature and that sort of thing. To make sure you haven’t got an infection.’
‘I saw the doctor only last month and he said it was fine.’
‘A lot can happen in a month.’
‘Such as…?’
‘Such as a urinary tract infection.’
‘A what?
‘A urinary tract infection. They’re easy to pick up, but the good news is, they’re also quite easy to treat. They can make you feel really off colour, though. Quite confused…’
‘I’m not confused.’
‘Your family have said you haven’t been yourself lately. And one of the reasons could be – one of the common reasons – is that you have a urinary tract infection.’
‘I’ve never had one before.’
‘But it’s possible you’ve got one now. That’s why I’m here. To check.’
‘I shan’t let you.’
‘That’s okay. But I need to reassure myself that you understand what it is you’re saying no to.’
‘In all my years – I’ve never been spoken to like this. It’s quite extraordinary.’
‘I’m sorry you think so.’
‘And who did you say sent you?’
‘The doctor. Now – Rachel. Would you at least let me take your blood pressure?’
‘If you must,’ she says, leaning back, letting her head loll back on the wings of the armchair and stretching out her arm.

Actually, her obs are pretty good. Nothing much to suggest infection. The fact remains, though, that the primary purpose of the visit had been to obtain a urine sample, and Rachel steadfastly refuses to give one. Even though I’m pretty sure she doesn’t understand the logic of the request, there’s nothing more I can do. It’ll be up to the carers to get a sample at some point, or for the GP to prescribe some antibiotics speculatively.
I finish writing up the notes, put the pen down, and shake my head.
‘Do you ever get those days when nothing, absolutely nothing, goes according to plan?’ I ask her.
She laughs, and gently claps her hands.
‘No!’ she says. ‘I can honestly say, I never have!’

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