I’m due to rendezvous outside the patient’s address at four. I’m a little ahead of schedule, though, so I find a shady spot to park, and settle down to check my emails.
Just down the road a bus is suddenly at loggerheads with a van. The van didn’t give way to the bus, and now they’re both stuck, neither reversing, both of them leaning on their horns occasionally. The bus driver puts his hazards on and tries to get off the bus, but there’s not even room to do that. Traffic builds up north and south. Pedestrians stop and watch, some of them filming on their phones. Eventually, after about ten minutes or so, the van driver reverses. I wonder what’ll happen when the bus passes the van, but incredibly, he gives him a decorous little wave, like the Pope offering benediction from the balcony. In retrospect, I figure that’s even more infuriating than a lot of shouting and swearing. I admire his control.
Rosa’s blue car pulls up behind me.
‘All right?’ she says, coming round to see me, pushing her bling sunglasses up onto her head. ‘Waiting long?’
We’ve come to see Lena, an elderly woman who suffered a stroke a few years ago and is now looked after by her daughter, Carol. It’s not clear why we’ve been called in. The regular carers have pulled out for unspecified reasons – often code for a falling-out with the family. I haven’t been to Lena yet, but Rosa has, and she gives me the lowdown.
‘She’s a donkey on the edge, so watch yourself,’ she says, hefting her bag onto her back and slamming the boot shut. ‘She stands over you the whole time and tells you what you’re doing wrong. Just let it wash over you, if you can. She’s already had a run-in with a couple of the others. I don’t know what the long-term plan is, but it’s all a bit of a mess so just keep your head down and do your best. Oh yeah – and the other thing she does is try to get you to take out the rubbish. I don’t mind, particularly – anything for a quiet life – but it’s a bit cheeky. It’s not even clinical waste half the time, and she’s perfectly capable of doing it herself. See how you feel, though.’
Rosa leads the way into the flat, whose door has been propped open with a caterpillar-themed draught excluder. There’s a radio playing loudly in the kitchen at the far end, no other signs of life.
‘Hell-ooo!’ sings Rosa. ‘Car-ers!’
No-one comes. Lena’s room is immediately on the left, but just as we start heading in a figure appears at the far end of the corridor – Carol, a lean, middle-aged woman with tight curly hair and the kind of glasses you might doodle on a picture. It’s alarming how much those glasses intensify the sharpness of her expression.
‘I’m sorry – and you are…?’
‘Yes. Not you. I’ve met you before. This other gentleman…?’
‘I’m Jim,’ I say. ‘Rosa’s colleague.’
‘Right. Well. Mummy’s through there, as you know. The enema worked yesterday so that’s a relief. You know what to do, don’t you? I know you do, because you’ve been before.’
‘Yes,’ says Rosa.
‘Let me know if you need anything,’ says Carol, and she retreats back into the kitchen.
Rosa risks a told you so face, and leads the way in to Lena.
Our call here today seems pretty straightforward. Lena’s pad is clean and dry, so after freshening her up and applying the bed sore creams, we straighten things out and get ready to leave.
‘What do you think you’re doing?’
Carol is standing in the doorway.
‘Lena’s pad was clear so … erm… everything looks good.’
‘It certainly is not good. You haven’t helped her empty her bowels.’
‘Her bowels! Her bowels! Oh for goodness sake! Haven’t you been trained…’
She stamps round to Rosa’s side of the bed and snatches the control from her.
‘Give me that!’ she says, raising the bed up again. ‘What is the point of you coming if you can’t do the simplest thing? Okay, mummy. There we are…’
She unfastens the pads, then rolls her on her side by pushing on her hip.
‘That’s it, mummy. Now draw your knees up. Good. Okay. Now push, mummy! Push!’
Lena begins making grunting sounds as she bears down. Carol grabs a tissue from a box at the foot of the bed and manually expresses the bowel motion like a midwife delivering a baby.
‘There we go! That’s it! A little more!’
Then she tosses it into a nearby bin and rolls her mother onto her back again.
‘The carers have been doing this for three years,’ she says, fixing the pad into position again. ‘Three!’
‘Well – we haven’t,’ says Rosa. ‘And I have to say, this isn’t part of what we do.’
‘What do you do, then? Nothing of any use.’
‘No. If the patient needs their pad changing and what have you, we’re happy to take care of that. And if they need the toilet we’ll help them onto a commode…’
‘She can’t stand, for God’s sake!’
‘No – well, she should really be hoisted, then.’
‘I don’t have a hoist.’
‘Either way, we can’t do any manual bowel procedures. That’s for the nurses. We’d be in big trouble…’
‘I don’t like your attitude. I want you out of my house. Right now. And I’ll make sure that you never come back.’
‘I’m sorry you feel like that,’ says Rosa, peeling off her blue gloves.
We’re half way down the corridor when Carol shouts out:
‘And take the rubbish!’