It’d been a year since I last saw Vera. I remembered her clearly, though. A bracingly independent woman in her nineties, Vera had been non-compliant with everything – meds, treatments, appointments – and so utterly resistant to any offer of help she’d physically ripped up the paperwork in front of Marion, the physiotherapist, and handed back the empty folder. Reports were that Vera had declined a great deal since then, unfortunately. Several admissions to hospital with falls and so on. A recent stay for increased confusion, reduced mobility. Ill health had softened her up a little; she’d accepted a couple of care calls a day, and we were in the process of ordering a hospital bed, and doing whatever we could to set up a micro-environment so she could stay at home.
‘The doctors are saying palliative, not quite End of Life phase, but not far off,’ says Marlene, the lead nurse. ‘See what you can do.’
As soon as I let myself into the flat I know something’s wrong.
‘Vera? Hello? It’s Jim, from the hospital.’
A muffled voice from the bedroom.
I’m on the floor.
Vera’s lying so close to the door it’s tricky getting in. I have to take my jacket off, put my bag down, cheat a gap just wide enough to squeeze through sideways, and then reach back through for the bag.
‘Have you hurt yourself, Vera?’
‘No. But I can’t get up.’
‘Let’s just have a look at you.’
Vera has slipped off the bed, dragging the quilt down with her and landing semi-recumbent on the carpeted floor with the quilt rucked-up behind her back. As landings go, pretty neat. I check her over, just to be sure. She has no power in her legs, and she’s too big for me to help up on my own.
‘I’m going to have to call the ambulance, Vera.’
‘Look – never mind that. Just listen closely. There’s a leather suitcase over by the window. I want you to take it to the bank. To the manager. The manager will then lock it in the vault. D’you understand me? A leather suitcase! For the vault!’
‘Okay – but – first things first, Vera. I’m just going to call for an ambulance along to help with the lift, and when we’ve got you up and everything, we’ll think about the rest.’
The ambulance call taker goes through the usual triage algorithm, as tedious as ever, but I understand the reason behind it. Except – this particular call taker has an unfortunate tone, robotic and quite aggressive.
‘How long has the patient been on the floor?’ he says.
‘It’s hard to say. Vera’s not a particularly reliable witness, I’m afraid. But the flat’s nice and warm, she’s comfortable and not in any distress, so I don’t think any of that’s a problem.
‘Can you place your hand in the middle of the patient’s chest and tell me if they’re cold or not.’
‘I’ve got a thermometer in my bag. I could do a temperature if you like.’
He simply repeats the question, a little more slowly.
‘Look,’ I tell him, feeling riled, ‘I’m sorry but I’m not going to be placing my hand on her chest or anywhere else.’
‘Are you telling me that you’re refusing to carry out my instructions?’
‘I just don’t think it’s necessary.’
‘In that case I shall be making this case a higher priority.’
‘Great. Suits me. I don’t particularly want to be waiting here for hours.’
‘The patient has now been triaged as a Category Red 2 response: possible hypothermia.’
‘Fine. She’s not, but – whatever.’
I feel like telling him I used to be an EMT, but I don’t. It’ll probably make him worse.
He carries on with the algorithm, even though I offer to do a set of obs for him.
‘An ambulance will be with you shortly’ he says, giving me some worsening care advice and a reference number. ‘Thank you for your assistance,’ he says, coming to the end of the screen, and then adds, with a little shiver of personality: ‘Have a nice day,’ and rings off.
I’m halfway through my examination when the buzzer sounds. Five minutes later two paramedics come through the door – the lead one, Chloe, an old workmate of mine I haven’t seen since starting the new job. We kiss and hug and how are you and everything.
‘This is Prina’ says Chloe, introducing me to her colleague. We shake hands.
‘Me and Chloe go way back,’ I say to her, blushing slightly.
‘I didn’t think you were strangers’ says Prina.
I show them into Vera, who’s so comfortable on the floor she’s virtually asleep. I tell them the story of the fall and as much background information as I have. Between the three of us getting her up is easy. She has to go in to hospital, though. She’s not safe to be left at home – and really, shouldn’t have been discharged in these circumstances. Still, it’s always a difficult judgement call, complicated by issues of mental capacity and the incessant demand for beds.
Vera seems happy to go in – or if not happy so much as passively accepting. She’s cocooned in a couple of cell blankets on the paramedics’ carry chair, her frosty white hair spiking up out of the top, making her look like an enormous alien chrysalis retrieved from a glacier.
‘Don’t forget that suitcase!’ she says to me, suddenly perking up and wriggling dangerously from side to side on the chair like she’s about to break out and spread her wings. ‘It has to go to the vault!’
‘What suitcase?’ says Chloe, resting a hand on her shoulder. ‘What vault? Sounds intriguing.’
‘There’s nothing intriguing about it,’ says Vera, desperately chinning enough of a gap in the blankets so she can glare at Chloe. ‘It’s where I keep my manuscript!’
‘I miss working with you,’ she says, smiling at me. ‘There’s always something – I don’t know…’ But then she straightens up and nods to Prina. ‘You’re great, too,’ she says.
‘Oh – get a room’ says Prina.