I’ve come to do Elaine’s assessment with Lisa, one of the physio assistants. Elaine is eighty, her cancer advancing rapidly towards end of life, to the point where she needs a great deal more equipment and care. The District Nurses want her to go into a hospice, because she has no family or friends to help out, she’s isolated and vulnerable where she is, and there’s a limit to what the various community health teams can do. Elaine doesn’t want to go, though, despite numerous falls and incidents. The DNs have referred her to us to see what else we can provide, including night sitters.

We’re told that Elaine is able to buzz us into the building with a remote device, but when we ring her number there’s no reply and nothing happens. The building manager isn’t in his office, so we push the emergency buzzer on the console. Because we don’t know the password, and the door’s not camera monitored, they won’t let us in. We ask if they’ll phone the hospital and check that way. It’s not part of their protocol, they say. They can’t do it.
‘She might be on the floor,’ says Lisa.
‘Sorry.’
They ring off.
Lisa curses, buzzes random flats. Eventually someone takes pity on us and lets us in.

Luckily, Elaine’s door is unlocked. She’s sitting on the floor leaning back against the bed. The only injury she has is a skin flap on her arm, so together we gently help her up again and settle her back in bed. I check her over and dress her wound.
The phone rings. Lisa answers on Elaine’s behalf.
‘It’s Dwayne,’ she says. ‘From the Salvation Army. He says he’ll call back later.’
Elaine nods, gently raising and then lowering her uninjured arm like a marionette sadly acknowledging some change in her surroundings, then she gently closes her eyes and rests her head back. She’s so frail and emaciated she hardly makes any impression on the pillow.
‘Dwayne is so sweet,’ she says. ‘There are two of them, you know.’
‘Two Dwaynes?’
‘Identical twins.’
‘Buy one get one free,’ says Lisa.

Gently holding the primary dressings in place, I wrap Elaine’s arm in a bandage.

‘I used to play tennis with this guy,’ I tell her. ‘It was only a year later I found out he had an identical twin. For some reason it just never came up. I went round to pick him up one day and when he came to the door I thought Whoa! What’s different? He just stood there looking at me whilst I tried to figure it out. Was he wearing new glasses? Has he cut his hair? What was it? After a while he said So I’m guessing Simon never told you he had an identical twin? It was so weird! They were the same but different. Very unsettling.’
‘I’ve not met Dwayne’s brother,’ says Elaine. ‘I’ve only ever seen pictures.’
‘What’s his name?’
‘Dwayne.’
‘What – they’re both called Dwayne?’
‘No. Dwayne’s called Dwayne. I don’t know what the other one’s called. Something or other, I expect.’
‘I was gonna say. If you had identical twins you wouldn’t call them both Dwayne. It’s confusing enough.’
‘I dunno,’ says Lisa. ‘Might make it easier.’

I tape the bandage.

‘There! Good as new!’
I gather all the rubbish together.
‘You know – it’s only recently I found out you can’t have identical twins of different genders,’ I say, peeling off my gloves, adding it to the waste bag, then putting it in the kitchen bin.
‘You can, actually,’ says Lisa. ‘It’s pretty rare, but it can happen. It’s all about the fertilisation. If you get two eggs developing in the uterus you get fraternal twins; if you get one egg that splits in two you get identical twins, boy boy or girl girl. But then sometimes one of the halves drops the Y chromosome and you get boy girl identical twins. Very rarely though. See what I mean?’
‘‘How do you know all this stuff?’
She winks and points.
‘Stick to the bandaging, Florence. Leave the science to me.’
Elaine tentatively flexes her bandaged arm.
‘Oh dear,’ she says. ‘I look like Boris Karloff.’
She sighs and closes her eyes again.
‘Maybe I had better think about that hospice,’ she says.