I’ve never seen so much food. Walking into the kitchen I stop and shake my head in wonder. I’m like Howard Carter stumbling into the tomb of Tutankhamun, suddenly confronted by shelves piled high with fabulous riches: sweet chilli noodles; party packs of M&Ms; currant pastries; catering packs of crisps and cheetos (not for resale); a Colin the Caterpillar, happily gutted from the middle out; cream cheese n’chive pretzels; a plate of fruit (untouched); chocolate biscuits; chocolate rolls; chocolate truffles, chocolate for injection (I think) – and as if that wasn’t enough sugar, a shrink-wrapped twelve-pack of energy drinks.

It’s a perfect storm of junk food, and the reason for it is that there’s been a perfect storm of people leaving.

There are always good reasons to go. It might be the exorbitant cost of accommodation in the south. It might be better job offers elsewhere, better opportunities to train, or upgrade, or move into management. It might be the need to do something different, to shake things up, to rediscover what it was that drew you to nursing in the first place, or confirm what it was that made you want to quit. It might be burn out, ill-health, retirement, whatever. The fact is, though, if you take a step back, and breathe, and cast your eyes over the broader picture, you have to think this team’s retainment record is shot. It’s the kind of graphic you’d hastily click through in a presentation, or – ideally – omit from the slideshow altogether.

Honestly? I don’t know why things are so bad (national pandemic aside). Nursing in the community isn’t for everyone, that’s a given. You don’t have the immediate support you have in a hospital. You’re not surrounded by doctors and nurses and administrators and cleaners in a well-lit building with every kind of machine and every kind of clinician to work them. In a community health team, every day you’re stepping out into the medical wildlands, with only a kit bag, a nose for danger and a phone. It’s a level of responsibility that has some practitioners quickly developing a twitch, but for some it’s the perfect place to practice their skill. You’re forced to improvise, to adapt to the crazily different scenarios you walk into: environmental, social, medical. And until they develop a drone that will hover at your shoulder and offer reassurance and advice, YOU are the drone, and you’re flying by yourself.

*

It’s late in the evening. I’ve swapped hats, from nursing support to office administrator, helping on the phones, taking referrals, troubleshooting. I’ve just come back from the sugar nirvana of the kitchen with a handful of M&Ms, and I’m busy tossing them down my beak with one hand whilst I work through the patient list with the other. And suddenly – whether it’s something in the blue M&Ms, or that lucent kind of tiredness you get when you’ve been concentrating for hours – but I have a sudden moment of insight, and I’m not just scrolling through names on a screen anymore but through a landscape of scenes, drifting through them like a tiny, shiny, sugar-coated ghost. The woman who was discharged home to die, and promptly did die, that very afternoon, before any of us had a chance to see her. The man who self-discharged from hospital after an overdose, and went back to his boat to drink whisky and consider his options. The woman struggling to look after her husband whose dementia means he punches the cot sides all night and day. The man who took out his phone to film the occupational therapist when she called on him to see what he needed. The woman who nursed her husband through his last years, and now faces her own decline completely alone. The woman who cannot cope at home, but doesn’t want to leave her home, and the exhausted daughters who want us to simply put her in a home. The woman starving herself, staying in bed so long she has pressure sores. The woman with the new stoma, who died on the table, and saw God, and came back, and how angry she is about that, and the business of wearing a bag. Each scene merging into the other, blurring on the screen, until it’s not one or two patients anymore, but a never-ending roll call of problems, because for every one we solve and discharge from service, another two referrals come in.
‘GP on the line’ says April, the call taker in the hub. ‘Wants to know if we’ve got capacity for a faller…’
I toss down the last of the M&Ms, smack my hands clean, pick up a pen.
‘Put ‘em through.’

Because – I don’t know – what else is there?