It’s so hot it feels as if the sun has dropped in closer and burned away every last scrap of moisture. I’m okay though – waiting for the social worker in the shade of the tall privet hedge that marks out the perimeter of this estate. I don’t mind the wait. I stand with my bags at my feet, waving to the people coming and going along the driveway. The postman in his foraging cap with a strip of blue canvas hanging over his neck; the young couple striding out with a pram covered in netting; an elderly woman with her shades flipped up, her permed hair glinting metallically in the sun. It starts to feel strange, like I’ve been standing like this for years. When the postman comes out again I half expect him to come over and hand me a letter: To the Man by the Hedge. ‘Dear Standing Man…’
Liam the social worker hurries across the road, hugging a battered leather briefcase to his chest, looking right and left over his shoulder like he’s escaping with secrets and expects to be shot.
‘Phew! Sorry I’m late!’ he says, striding towards me over the lawn. ‘Have you made contact?’
‘No. I thought I’d better wait.’
‘Good. Good,’ he says, pushing back his long hair, the sweat standing out on his forehead. ‘Well, then. Shall we…?’
Nanette’s daughter Roo answers the door.
‘Thank you for coming,’ she says. ‘Although quite what you’ll be able to do I don’t know.’
It’s a difficult scenario. Nanette was discharged home after some disagreement amongst the clinicians about her mental capacity. Nanette has chronic health problems, made worse by a recent infection. Her history of taking medication is patchy to say the least; she prefers to take herbal remedies, to meditate and follow a strict dietary regime – all of which is fine, of course, except it’s reached the stage where it’s difficult to say whether the progress of the illness is affecting her ability to make rational decisions about her health. She was so unhappy and disruptive on the ward, the hospital took the view that on balance she’d be better off at home with the support of community health teams.
None of this would matter so much if Nanette wasn’t suffering, and putting herself at considerable risk.
‘She was outside last night in the early hours, knocking on random doors asking for ice cream,’ says Roo, taking a steadying breath. ‘I live miles away. I just can’t be here all the time.’
What makes it even harder is that Nanette won’t accept any care support. She’s been turning people away, shouting at them through the window, telling them to piss off, and worse. The self-neglect is starting to show now. I’ve been sent in with Liam to do as much of a review as she’ll tolerate, to see how she is and what more can be done short of sectioning.
We put on our masks and gloves and follow Roo up the stairs.
Nanette is sprawled on the sofa. Emaciated, a dump of stringy limbs loosely wrapped in a threadbare dressing gown. The tiny flat is super hot; the little fan turning its head ineffectually right and left and back again, like a sad little robot saying no, no, no.
‘Hello Nanette!’ says Liam, giving a little nod. ‘I’m Liam, a social worker, and this is Jim, a nursing assistant. We’ve come to see how you are.’
‘Well now you’ve seen me so you can piss off,’ she says.
‘We’ll go if you want us to, but first we’d like to see how things are and how we can help.’
‘You can see how they are,’ she says. ‘They’re hot.’
‘I know. It really is hot today,’ says Liam. ‘Would you mind if we sat down over here and had a quick chat. We won’t keep you long. Promise.’
‘If you must,’ she says.
Roo fetches in two small, brightly coloured stools, the kinds of things you might find in an infant school. We sit with our knees up to our necks, and try to smile with our eyes over the rim of our masks.
‘Would you mind if I did your blood pressure and so on?’ I ask her.
‘I’m fine!’ she says. ‘Why is everyone so obsessed with blood pressure? This is what’s wrong with the world. Haven’t you got anything better to do?’
‘Not at the minute. We’re here for you.’
‘Well that’s nice,’ she says, not meaning it. ‘Go on then. But don’t pinch.’
I run through her obs, which are surprisingly good, considering.
‘Thank you!’ I say, sitting back down on the stool. ‘That’s all fine.’
‘I told you! You won’t listen. There’s nothing wrong with me. And if there is, I cope with it my own way…’
‘Who’s that in the photo?’ says Liam, nodding over to a large, gold-framed, hyper-colourised photo of an Indian man in yellow robes, a string of flowers round his neck. He’s holding his hands out, palms-up, smiling so widely his eyes are creased shut.
‘That’s my guru,’ says Nanette. ‘I followed him for years. He died a little while ago.’
‘I’m sorry to hear that,’ says Liam.
‘Dont’ be,’ says Nanette, painfully pushing herself up on her elbows. ‘See that other picture, there? The one to the right?’
In a silver frame. A shaky, grainy, long-distance shot of a young Indian guy in white robes, striding onto a stage in front of a huge audience.
‘He came back,’ she says.