moth orchids

For the life of me, I cannot figure out this gate. It’s held with a strange drop-down mechanism I’ve never seen before, something you have to raise up then angle straight out so the hoop of the gate can pass over it. Something like that.
Brenda watches me from the back door.
‘There!’ I say. ‘Made it!’
‘Well done!’ she says, clapping in that speeded-up way people do with their wrists together. ‘It is fiddly!’
She stares at me so intently, her makeup and hair so perfect, her pink slacks and knitted white cardigan so – I don’t know – central casting, I get the strange feeling I’m in a sitcom. And I’ve forgotten my lines.
‘Come on in!’ says Brenda, improvising to cover. ‘We’re so grateful you stopped by.’
I follow her into the front room. It’s as immaculate as Brenda, of course, with the same, stagey aura of perfection.
‘Shall I fill you in on some background?’ she says, gesturing to a sofa.
‘Sure.’
I put my bags down, and when I sit on the big cream sofa, it’s hard to resist sitting exactly like Brenda, knees together, legs angled off to the left, like a debuttante or something.
‘I’m worried about James,’ she says, massaging the rings on her gnarly fingers.
‘I’m sorry to hear that, Brenda. Why? What’s been going on?’
‘He’s not himself. Six weeks ago we were on the bus together, going off along the coast, having a lovely day out. Having adventures. I mean – he’s never been the chatty sort, but if you ask him a direct question – nose to nose! – he’ll answer you alright!’
When she says ‘nose to nose’ she puts the flat of her hand to the end of her nose, then peeks round it, and smiles.
‘So – six weeks ago, James was his normal self. And now… what’s happened?’
‘Well he’s just become sleepier and sleepier, until this last week he can’t even get out of bed.’
‘Oh?’
‘It’s really not like him. He’s normally so active. I’m so glad you’re here because otherwise I don’t know what I’d do. I’ve got Steven of course, our son, and he’s wonderful. But he’s not a doctor, is he? He’s as worried as me.’
‘Well I’m sorry to hear you’ve had a difficult time of it, Brenda. Shall we go upstairs and say hello to the man himself?’
‘Yes!’ she says, brightening and standing up. ‘We’re both so grateful for the NHS. You’re lifesavers, really you are.’
‘That’s kind of you to say so.’
‘Oh I mean it. I have nothing but admiration for the work you do.’

I follow her up the stairs, past a pot of green and white moth orchids, reaching down towards us from their alcove.

James is lying on his side in bed, his flushed and veiny face quite a contrast with the crisp, white duvet. Brenda walks round to the other side and gives him a tentative shake.
‘Jimmy? Darling? It’s a nurse from the hospital. He wants to see how you are…’
James slowly opens his eyes and stares blankly at me. Then he smiles and mouths the word hello.
He does seem very sleepy, nodding off when I talk to him. And whilst it’s true the room is warm and close, still I’m concerned. I take a set of obs, which surprisingly come back as normal.
‘And six weeks ago you were off together on the bus for a day out?’ I say, feeling his pulse, wondering what on earth is going on with his guy.
‘Yes! He’s always been so fit. I can’t understand it.’
‘Has the doctor actually visited James?’
‘No,’ she says. ‘They rang me up and we had a chat. I don’t know what to make of it at all.’

I phone the lead nurse and we talk through the situation. She agrees that it’s a good idea to take some bloods and see if that sheds some light. Meanwhile, we book in a follow-up nurse visit for later in the day.
‘We’ll be in touch!’ I say, waving to Brenda as I walk back through the front garden, expertly flipping the gate latch. with one hand.
‘Thank you so much!’ she says, then steps back inside, and quietly closes the door.

*

Later that day I talk it over with the nurse who took the follow-up visit.
‘It’s strange,’ she says. ‘He looks really unwell, but I can’t put my finger on it. Brenda says six weeks ago they used to go on the bus along the coast. I couldn’t decide whether his speech was affected or not. Brenda says he’s never been chatty, but if you ask him a direct question nose to nose…’
She makes the same hand gesture that Brenda did when she told me the story, too.
‘Brenda’s known to the memory clinic,’ I say to her.
‘Er-hum,’ says the nurse. ‘But she seems pretty fine for all that.’

*

The bloods are all fine. Nothing at all to indicate any acute illness, nothing to explain his sudden six week decline, increased lethargy and inability to get out of bed.

I try ringing Steven, the son, for some more information, but his phone keeps going to voicemail. In the end I decide to book in some further nursing visits, and to email the GP with a breakdown of what we’ve found, and what we think might need to happen next, including CT head to exclude any acute changes there.

Luckily, I try one last time to call Steven before I send the email.

‘You know mum’s got dementia, right?’ he says.
‘Well … I read she was known to the memory clinic.’
‘Right!’ he says. ‘She’s pretty confused. I know she presents well, but honestly, she’s clueless. The thing is, up till now she’s been the one getting dad out of bed in the morning. Ever since his stroke he’s been much less active. If you left him to it he’d just stay there all day. Once he’s up he’s not too bad, but he needs a lot of encouragement. Mum’s been good up till now, but for some reason these last few weeks she’s not so able. She’s got this idea he’s going to fall and it’ll be her fault, or something. I don’t know. Anyway – I do what I can to help out, but I can’t be there every morning. I’ve got a job and my own family to take care of. So that’s why the GP got you lot involved.’
‘So this story about how six weeks ago they were off on the bus together along the coast…?’
‘Six years, maybe.’
‘And you’re not worried that your dad’s more unwell?’
‘Dad? No! He’s the same. I mean, look – he’s never been what you might call chatty…’

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