One of those headlong, breathless mornings, where I’m furiously trying to fit too many visits into too few hours, with the hopeless intention of being back in time to relieve Mandy on the desk at one. Mandy only came in because she heard we were short. ‘One day they’ll put up a statue of you in the marketplace,’ I tell her, almost spilling the tea I’ve made as an extemporary thank you. ‘What – so the pigeons can shit on me?’ she says. ‘Thanks for the tea.’
It’s the kind of morning where I’m overly conscious of my heart. I feel it swinging on a piece of frayed string, side to side, side to side, the joke pocketwatch you might hang inside the ribcage of a medical skeleton. All my timings might work if everything clicks – here then here then here via there – tick tick tick. Back by one. Yeah, right.
And of course, not one thing goes to plan.
The first assessment turns out to be much worse than the breezy drive-by the GP promised in the referral. I’m met at the door by a carer so stressed you can see it trembling through her like a tractor on a pinking idle. She has her mask under her chin like it’s stopping her mouth falling open into a scream; even worse than that, she’s carrying a knife.
‘Can you pull your mask down, too?’ she says, gesturing with the knife. ‘My hearing’s not what it was.’
I tell her I’ll speak up, then, because I can’t really take the mask off. It’s more for the patient than my benefit.
‘She’s jabbed, though,’ says the carer, like she did it personally, with the blade. ‘Twice.’
Even so, I tell her, she can still get pretty sick with Covid. Especially given how frail she is. I say I’m sorry but I just can’t do it.’ This doesn’t go down well. I follow the carer into the kitchen. She rushes through a handover whilst she dices her fingers with the cucumber. ‘Can you at least help me change her?’ she says.
‘She’s stuck on the sofa.’
All in all I’m at the house for two hours, late for my next call.
But it’s fine. It’s okay. This next one should definitely be quick. I’ve been asked to drop in to an elderly patient just to check his obs, see how he is, weigh him and check his pressure areas, so we can discharge from our service. It’s a formality. I can make up time there.
I let myself into his flat with the keys from the keysafe. A Welsh dresser narrows the hallway and I have to turn sideways to get through. There’s a ribbed-glass door just ahead so fiercely illuminated it’s like stepping onto the deck of a spaceship orbiting the sun – except, a spaceship with a threadbare carpet and faecal footprints tracking from the soiled cot bed in the corner to the captain’s chair by the window. Before I go any further I put some shoe covers on. Check my fob watch. The air is thick and noisome.
‘Hello Mr Carpenter,’ I say, going over to him, lightly waking him up by resting a gloved hand lightly on his shoulder.
‘Wha-at?’ he says, with a start, wide-eyed at the rustling, white-gowned alien looming over him.
At first glance he seems immaculate. Like James T Kirk started modelling in his dotage for a geriatric gentlemen’s outfitters, smartly put together in a sharp check jacket, pink stripe shirt, belted trousers and some impressively elaborate leather boots that zip up right and left from the toe to the bend of the ankle. I can see a glob of faeces on the heel of his left shoe, and a slide mark emerging from the hem of his trousers.
‘My name’s Jim. I’m a nursing assistant. From the hospital. Come to see how you are!’
He bats the air, then linking his hands on his lap, rests his head back again.
He’s obviously been incontinent, but before I do anything else I run a set of obs to see if he’s acutely unwell or not. Everything seems fine, though, and his vagueness is probably due to his advanced dementia. I help him stand up, loosen his trousers, and peer into the horror below. His mobility is pretty poor, and I know I’m not going to be able to wash him on my own – especially given the tiny bathroom with no aids of any kind. I sit him down again whilst I ring his care company. He’s not due another call until the evening, they say – and no, they don’t have anyone they can send out to help me. ‘He needs more care,’ I say. ‘We’re in discussions about that,’ they say. So I phone the office. Mandy says the only person available to come out is Tim, a new carer still on induction. ‘It’ll be the Jim and Tim show!’ she says. I tell her I’m almost certainly going to be late back. ‘Don’t worry,’ she says. ‘I’ll just stay on a bit longer.’ I tell her the statue will be made of gold, with diamonds for eyes. ‘Oh yeah?’ she says. ‘Just make it in concrete and throw me the diamonds.’
Whilst I’m waiting I clean Mr Carpenter’s hands, then go into the little galley kitchen to make him a cup of tea. There are sandwiches laid out for him on the side – not that he’d have any idea they were there. When I give them to him he eats them hungrily, taking big toothless bites, craning forward at the neck like an ancient tortoise with a lettuce leaf. Whilst he’s tucking in I strip his bed down, clean it up and put on fresh linen. Use antiseptic wipes to get the worst of the mess from the carpet.
Tim arrives. Between us we help Mr Carpenter up, strip him down, walk him to the bathroom, clean him off. Tim is great, chatting to Mr Carpenter and teasing out little scraps of information. Apparently Mr Carpenter was a civil engineer. ‘How amazing!’ says Tim. ‘My brother’s an engineer. He makes hovercrafts.’
‘I’ve been on a hovercraft,’ I say.
‘Oh really?’ says Tim.
‘Yes,’ I say. ‘To the Isle of Wight.’
The Isle of Wight suddenly seems like a very strange name. The Isle of Wight? I really went there? On a hovercraft?
Meanwhile, Tim is saying how his brother was always interested in bridges.
We dress Mr Carpenter in a new set of clothes – sans jacket, unfortunately, which also has to be added to the small mountain of soiled clothes and bed things we leave for the carers to deal with later. Then we help him back to the armchair which we’ve cleaned and covered in a beach towel, and settle him in. He eats the other half of his sandwich whilst Tim pours some orange juice and puts the glass beside him. Mr Carpenter smiles and holds up the remaining crust from his sandwich – working the upright part of it like a hinge.
‘Come on Down!’ he says. ‘Come on Down!’
‘The Price is Right! Bruce Forsyth!’ I say.
Mr Carpenter stares at me, then drops the crust back on the plate.
‘Finished?’ says Tim. ‘Good!’ then takes the plate away.