You wouldn’t need a doctor to tell you Tommy is dying. And exactly what he’s dying of is anyone’s guess. For whatever reason, Tommy has consistently refused any treatments or investigations, opting instead for a slow decline at home. These last few weeks his friend Mick has been looking after him on his own; now, things have taken a turn for the worse, and Tommy needs caring for in bed. The GP has referred him to us in the short-term, to handle the immediate care and equipment needs, and to the District Nurses, to case manage in the closing days or weeks. We’ve managed to install a hospital bed with a dynamic mattress, slide sheets and other equipment, provided carers to double-up with Mick; anticipatory meds are pending, and a DNACPR is in place. There’s not too much else to be done but monitor, make comfortable, and wait.
Tommy is lucky to have Mick. A neat, level kind of guy with a smile as frank as his handshake, he has that rare skill of being able to talk directly without seeming bossy or hard-edged. Tommy’s basement flat had been a little chaotic to begin with, and it’s amazing to see what improvements Mick has made in such a short amount of time. He’s managed to arrange things just-so, enough room for the carers to work safely, without anyone losing sight of the fact that it’s Tommy’s home, a place he wants to die in, with his things around. To help keep everyone on track, Mick has discreetly pinned up lists of essential information. The nursing folder’s in good order, with the DNACPR form readily accessible at the front.
He wakes Tommy by stroking the top of his arm and leaning in: ‘It’s Jim, Tommy. Come to see how you’re getting on.’
Tommy opens his eyes and turns his head, blindly.
‘Is there anything I can do for you this morning, Tommy?’ I say.
He manages to raise his right hand a little, and I take it, giving it a gentle squeeze. Then he relaxes back into the bed, and closes his eyes again.
‘There, look! You’ve worn him out!’ says Mick.
After the visit, making the steep climb back up the dark basement steps to street level, I feel like I’m emerging from the underworld. Everything’s so bright and active, so powerfully alive. Tommy has lived here fifty years, and I expect it’s always been busy, one of those high street tributaries, a mixture of shops and private flats, everything piled higgledy-piggledy, one on top of the other. The sun’s out, it’s lunchtime and the street is particularly frantic, workers out foraging on a lunch break, delivery vans delivering, scaffolders banging and shouting overhead, everyone with somewhere to go and going there quickly, some of them checking their phones as they walk. There’s one still point amongst the carnage, though – an old guy, sitting halfway down on a stoop, leaning against the railings with a sketchbook on his lap, drawing with a pencil. He certainly looks the part, in a battered fedora hat, linen jacket and scuffed brown shoes. I like the way his hat accentuates the tip of his head as he continually moves between the page and the street. I’m parked just a little way beyond, and as I walk by I can’t help glancing at what he’s drawn. It’s completely wild, a vigorous swirl of lines and rough shading, with everything in the street, the people and trees and cars and buildings, even the clouds – everything rushing together.
‘Looking good,’ I say.
He glances up at me and nods. And I might be wrong, but I have the distinct impression he sights me along his pencil as I walk past him to the car, and adds me to the chaos.