Derek is sitting on the sofa, both legs stretched out on a stool, a tartan throw neatly draped over his lap – so precisely aligned it’s like a draughtsman has lain a grid over the lower half of him pending further work. Derek is cradling half a mug of tea on his belly, only freeing a hand now and again to point aggressively, either at me, or at Mia, the nurse who’s come to do the assessment with me.
‘Listen to me… just for one second,’ he says, in a hoarse and curiously fractured way, zoning in and out, soft one moment and aggressively emphatic the next, as if he’s speaking from a great distance and the signal keeps getting distorted, ‘I do not appreciate… I do not appreciate…yeah? All this, what you are doing. It irritates me, high up, in here…’ slowly transferring the pointing finger to his right temple and tapping, firmly, twice. I wonder if that’s the side he had the stroke, and I make a note to ask his wife Sandra about it. ‘I do not appreciate this,’ he says. ‘I do not want it. Let me tell you something. I have been round the world. A few times. I’ve walked it. The entire world. And I’ve seen things. You wouldn’t believe what I’ve seen. I’ve seen people killed. Yeah? You cannot imagine…’
‘You’re absolutely right,’ says Mia. ‘I can’t. But – if I could just explain why we’ve come here today…’
Mia is unflappable. She wears her long years as a community nurse lightly, but with great warmth. It’s impressive to see how patiently she’s able to maintain her focus in the face of Derek’s behaviour, not rising to his challenges, progressing the meeting as best she can, slowly and neutrally, her clinical objective always in mind. I feel like a naturalist taking notes on a species of big cat, stalking its prey on the prairie. It’s instructive to watch her work, to see how she continually makes tiny adjustments to her approach, the way she sits, the way she puts her notes to one side, the way she holds him in her attention. If she had a tail it would be switching, infinitesimally, at the tip.
‘No! Now – wait!’ says Derek. ‘Let me tell you something.’
‘Please let them help you,’ says Sandra.
‘It’s okay, Sandra,’ says Mia, reaching over to touch her on the arm. ‘We’ve got time.’
‘And you!’ says Derek, stabbing the air in the direction of his wife. ‘You I’ll deal with later.’
‘Oh, Derek,’ says Sandra.
‘You know what you did. You let them in. You know I didn’t want them.’
‘But you’re ill.’
‘You I don’t mind’ he says, turning his attention back to Mia. ‘‘I don’t … have trouble with women. And I’ve known a lot of women in my time. You would not believe. But men? I’m a fighter. I’ve always been like it. Him,’ he says, flashing a sideways glance at me. ‘Him I would’ve had outside in a second. In a second.’
‘I’m sorry you feel like that,’ says Mia, smiling at me. ‘Now – look. it’s important that I explain to you why we need to see you today.’
‘No. Wait a minute. Listen.’
‘Derek! They’ve got people to see. They’ve got lives of their own.’
For the first time in the visit Sandra looks utterly forlorn.
‘I do not want a thing,’ says Derek, adjusting his position on the sofa with an uncoordinated lurch and slopping tea onto his t-shirt.
‘Oh now look! I’ll go and get a cloth,’ says Sandra, taking the mug from him. ‘Would either of you like a cup?’
‘That’d be great. Thanks.’
Sandra hurries into the kitchen.
‘Derek. We think you have an infection and we’d like to do something about it,’ says Mia, taking advantage of the distraction to strike the point home. ‘If you don’t let us help you it’ll just get worse and you’ll end up in hospital. Again. We respect your decision to say no, and we certainly wouldn’t go against that. But you have to understand what’ll happen if you don’t accept treatment.’
Derek closes his eyes, compresses his lips into a ghastly smile, and slowly shakes his head from side to side.
‘Just you listen a minute to me,’ he says. ‘You’ve had your say. Now it’s my turn.’
Weirdly, he almost seems to go to sleep, but when no-one speaks he suddenly opens his eyes again and points at Mia.
‘I’ve been round the world,’ he says. ‘I’ve seen people killed. I’ve seen people kill themselves, but it’s worse when they get killed. Can you – appreciate – what it is I’m trying to say to you? The whole world? Because I do not appreciate …. it gets me irritated …. up here. You do not get what I am telling you. I have been round the world, I’ve seen it…’
Sandra comes back in with a tray of tea.
‘There!’ she says, handing me and Mia a cup. ‘Although what I think you really need is a medal.’
‘I’ve been round the world. I’ve seen it,’ says Derek.
‘I know darling. And got the t-shirt.’
‘What?’ he says. ‘What t-shirt?’
‘Never mind, never mind,’ says Sandra, ‘I’m sorry.’ And sinking back down into the chair facing her husband, she straightens her skirt and takes a breath. ‘So. How far did we get?’ she says. ‘Anywhere?’