Thomas is alert but strangely neutral, propped up on the ambulance trolley, his white hair wild on the pillow, his mouth slack. He’s put on so much weight it’s taken a team of four to wheel him off the ambulance, up the drive, through the portico and into the house. Jenny the OT and I have arrived just in time to help, although there’s not much for us to do other than carry in all the bags of personal possessions, drugs and so on. The patient transport crew are a loud and pleasant bunch, eyes smiling over their masks, plenty of to you / to me banter as they patslide Thomas into bed, make things good, get ready to go. One of them nods for me to follow her back out to the truck, though.

‘I don’t know what help you can give them,’ she says. ‘But I gotta tell ya – I’m worried about the daughter. She’s a donkey on the edge. See what you think. Personally – I don’t know – I wouldn’t put money on it.’

The story is that Thomas went into hospital after a fall, stayed a month, then got transferred to a nursing home for a few weeks’ rehabilitation. Meanwhile, the hospital OTs visited the house, put in a hospital bed, stand aid, commode and so on, and then referred him to us for more therapy and nursing support, along with bridging care until a full time agency can take over. All in all it’s about as much as anyone can do short of adoption, or residential care, of course. But we’ve been tasked to visit for the initial assessment, to see how it all looks, and if the plan is workable.

The house is like a spacious, somewhat incongruous pink Spanish villa, set back on a rise at the head of the close. Thomas’ hospital bed has been set up in the L of the vast, low-ceilinged living area, with bare stone walls, a heavily-timbered fireplace, brasses hanging here and there, a hunting horn, a few framed portraits. Even though it’s hot and bright outside, the late summer morning doesn’t penetrate overmuch; what light there is only makes it so far through the patio glass at the far end, lying like a glossy green sweat on the backs of the clubby sofas and chairs.

In fact, the scale of the place is a little overwhelming. It’s the details that make you dizzy. On the wall behind the head-end of Thomas’ bed is a giant oil-painting of a horse’s head; at the foot of the bed, on a granite pedestal, a fish tank filled with tiny silver fish.

Thomas’ daughter, Helen brings in a giant mug, filled almost to the brim with tea.
‘Don’t spill it!’ she says to him, putting it on the overbed table.
He glances down, shakily jerks his hands, the tea slops.
‘Look what you’re doing!’ she says.
I take the cup from him, move the table to one side, hand the cup back to Helen.
‘He really needs one of those spill-free mugs – you know – the ones with the spout.’
‘What – like kids use? For kids?’
I nod.
‘That’s it!’
‘Have you got any?’
‘We don’t carry them. But you can get them anywhere. The supermarket, pharmacy…’
‘A beaker for kids? You mean Tommy Tippee?’
‘A lot of people use them.’
She looks horrified, takes the tea back into the kitchen.

Whilst Jenny starts doing the paperwork and an audit of the equipment we’ll need to check, I run some basic obs. It’s immediately obvious things aren’t right.
‘I think this is looking like a failed discharge,’ I say, looping the steth back over my neck.

Alice and Frank, two of our most experienced carers, turn up for the lunchtime call. It’s good to see them – they’re so cheerful and grounded, it immediately makes any situation a hundred times better. Between us we set about sorting Thomas out, log-rolling him, tearing off his pads, cleaning him up, putting on fresh pads, changing the sheets, sitting him up again. Thomas coughs throughout. Frank raises his eyebrows at me.
‘Tested for Covid?’
‘A month ago.’
‘Oh-kay…’

Helen appears in the doorway. She stands watching us, her arms folded, staring at the pile of sheets on the floor.
‘What’s that?’ she says. ‘Why’s that there?’

Jenny goes over to her to explain the situation whilst we finish up.
‘They’ve just had to clean your dad up and make him comfortable. Have you got a washing machine?’
‘What do you mean? I’m not doing any washing.’
‘It’s not too bad, Helen. It just needs tossing in the machine with a tab of something.’
‘Well you can do that because I’m not. Isn’t that what you’re supposed to do?’
‘No, I’m afraid not. We’re effectively an emergency service. The carers will be coming in four times a day for bed washes, pad changes, and then simple meal prep and medication if that’s needed, too. But everything else – things like washing, cleaning, shopping – well, they’re all classed as domestic chores. You’ll need to find someone to cover that if you can’t.’
‘Well I’m certainly not doing it,’ she says. ‘Why should I? I’m not touching anything soiled.’
‘You can put gloves on.’
‘Gloves? Gloves? I’m not putting gloves on. Look – you do what you have to do, but I can’t … I just can’t… I’ll go and stay at a friend’s if that’s what you think’s going to happen.’
Jenny looks over to me.
‘It might all be a little academic…’ I say, feeling Thomas’ pulse again. He sits propped up on the pillows, the focus of everyone’s attention, his mouth bouncing up and down, mute as a ventriloquist’s dummy who still has a whole bunch of things to say – important things, mad things, funny things – but the hand some time ago let go of the lever, and left him on stage to carry the show alone.