it wasn’t the pie

Ironically, of the two of them, Pete’s wife Sue had seemed worse. Her ulcerated legs were weeping through the bandages, and her breathing was laboured – exacerbated by a recent chest infection, and by all the cigarettes she’d smoked that morning.
‘I’d go mad if I didn’t have something,’ she said.
It was just yesterday I’d seen them both. I’d let myself in with a key from the keysafe, heard shouting from the front room. They were bickering over a Fray Bentos steak and kidney pie.
‘Am I putting two of these in?’ Pete said, presenting the blue and white tin to Sue, who was flipping through a TV Quick on the sofa.
‘Two? I’m hardly going to eat a whole one by myself, am I?’
‘Well I don’t know.’
‘No you don’t, do you’ she muttered.
He pulled the tin back again to scan it for clues.
‘For Pity’s sake! Just heat the one’ said Sue.
‘I’ll go and put the oven on then, shall I?’
‘You do that.’
‘Just this one?’
‘Just that one, Pete.’
‘And who’ll do the taters?’
‘Leave them on the side with the carrots.’
‘Carrots. Gotcha.’
‘And don’t go anywhere near the microwave.’
‘ Microwave. Yes.’
He hobbled off into the kitchen, stopped, and suddenly waved the tinned pie off to the side, like he was trying to pass it to someone only he could see. A moment later he drew the pie back into himself, and studied it closely again.
‘Alzheimer’s,’ said Sue.
‘Oven’s on,’ shouted Pete, coming back into the sitting room, still holding the pie.
‘What have you brought that in here for?’
‘What?’
‘The pie, love. The pie.’
‘Oh! Well! I’ll go and put it on then, shall I?’
‘Oh my good God.’

*

Next morning, Michaela had asked me to find out from the District nurses what the plan was for Pete. He’d only been referred to us following a recent report from the GP that his mobility was a little off, and the two of them were struggling to cope at home. As it turned out, over the past week we hadn’t actually needed to add too much on the care side. They had all the equipment they needed, and clinically he’d been okay. So we were referring back for on-going care to the DNs, especially Sue and her leg ulcers. Michaela particularly wanted to know if they thought Pete would benefit from more physio.
‘Do you mind?’ said Michaela. ‘Thanks, Jim!’

I had the time, it was a nice day, so instead of phoning I tucked the notes under my arm and strolled over to the District Nurses’ block.

Their offices are very different in character to the Rapid Response team, lighter and more spread out. They have a water fountain, plants – healthy ones – hanging from the tops of cabinets, the whole place open and sunny and relaxed. Sometimes, going in to work at the Rapid Response is like putting your head in a wasps’ nest and whacking it with a stick. This all felt much more humane. I resolved to get out of the office more often, and do more of these things face to face.

Rachel, the nurse I needed to see, was on the phone, so I took a seat opposite. I didn’t mind waiting. After a while she finished her call, took her feet off the chair, and turned her attention to me.
‘Hello!’ I said. ‘I’m Jim, over at Rapid Response. I’ve just popped over to ask you about Pete Rogers…’
‘Dead,’ she said.
‘What?’
‘He’s dead.’
I looked at the folder, as hapless as Pete with his Fray Bentos pie.
‘Peter Rogers? January twelfth, nineteen thirty-six?’
‘Yes. Sixty-two Alderney Drive. That Pete Rogers.’
‘Dead?’
‘Yes.’
‘Are you sure?’
‘I should think so. I was the one who certified.’
‘I can’t believe it. I only saw him yesterday. He seemed fine.’
‘He’s not now. What exactly did you want?’
‘Well one of the things was to find out whether you thought he could benefit from some more physio. Which I take it is a no. I just can’t believe it.’
‘We’re pretty furious, actually’ she said. ‘There were no anticipatory meds…’
‘He wasn’t palliative, was he?’
I flipped through the notes, to the GP summary we’d been faxed a couple of weeks ago.
‘Active problems – Alzheimer’s, mild COPD. Nothing about palliative care.’
‘Just hold it there a moment,’ she said. I relaxed the folder on my lap and looked at her. She gave me a coldly appraising look. ‘Tell me who you are again and what it is you do,’ she said,  ‘because I can’t tell from the way you’re dressed.’
‘I’m what they call an Assistant Practitioner. It’s a band four role, clinical assistant.’
(We’re supposed to wear a light blue tunic, but they’re unbearably hot to wear in the car, so most of us just wear polo shirts.)
‘Let me see those notes,’ she said. I handed them to her.
‘He seemed fine,’ I said as she flipped through the most recent assessments. ‘They were arguing over a pie.’ After a moment I added: ‘I hope it wasn’t the pie.’
‘Resp rate twenty. SATS of ninety-two. Who wrote this?’ she said. ‘If I’d found obs like that I’d have been straight on to the GP.’
‘Really? COPD patient. Smoker. SATS of ninety-two aren’t that unusual. And a resp rate of twenty doesn’t score anything.’
She wasn’t listening to me, but trying to read the name of the nurse who’d made the observations.
‘Can I have a copy of these notes?’ she said, handing them back.
I hesitated. I didn’t want to appear obstructive, but there was something steely in her manner that put me on my guard.
‘I’m sure that’s fine,’ I said. ‘But I think you’d better come and talk to my manager first.’
‘Why?’
‘I don’t know. Just to go over the facts and make sure everything’s clear. I don’t know enough about it.’
‘You could just run them through the copier.’
‘I’d rather you spoke to Michaela, if that’s okay.’
‘Tell her I’ll be over in five minutes.’

*

Michaela was as shocked as I was when I told her Pete had died.
‘Peter?’ she said. ‘Oh my God! Are you sure?’
But then when she checked through the notes on the system, the story began to unfold. The DNs had gone in and found him. There was a DNACPR in place. He’d suffered a cardiac arrest and that was that. Unexpected, in the strictest sense, anticipated to some degree. Certainly not palliative.
‘She’s coming over for the notes,’ I said to Michaela. ‘She wants a copy.’
‘I don’t mind. She can have a copy if she wants a copy. But I’ve just got to make a quick call to cancel the carers.’
She picked up the phone just as Rachel was coming down the aisle, covering the ground as smoothly and purposefully as a pilot on a travelator at the airport. She stopped at my desk and looked down at me.fraybentos
‘Won’t be long,’ I said.
She took a seat, folded her arms.

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