Alex reminds me of the sea captain in The Simpsons. If you rapped the TV with a wand, pulled the sea captain out of the screen by the shoulders of his great coat, gave him a shake to fill him out, swiped off his captain’s hat, pulled out his corn cob pipe and substituted it with a cheap Russian cigarette, took off one of his legs and sat him in a wheelchair – you’d have Alex. The orneriness you could leave.
‘No, no! Not there! THERE!’ he glares. I take a step back.
‘Okay. Off you go, Alex. I’ll stand here just in case.’
Alex has a routine for everything, which is fair enough of course, except it’s all so inappropriate and hazardous you have to bite your lip and cross your fingers and everything else and hope beyond hope he manages it. But the thing is – he invariably does. Which is half the secret with Alex.
‘How come he doesn’t bite your head off?’ says the coordinator. ‘Everyone else he tears a new one.’
‘Maybe he sees me as as pushover.’
‘Yeah?’ she says. ‘Or a kindred spirit. Still, at least he gets to see someone.’
I don’t like the way she says ‘someone’. There’s something of the dot dot dot about it.
Alex is what you might call a non-compliant patient. In fact. he gives non-compliance a bad rap. He’s forever self-discharging against advice, then throwing his hands up and calling for help. Then when the help comes, he puts so many demands on the various clinicians and therapists and carers he makes any meaningful intervention impossible. And to make the situation worse, he talks. And talks. And talks. Great rolling monologues that brook no interruption or question. Vast avalanches of discourse that will bury the novice unless they know the trick, which is to surf his words to a rapid and professional dismount on the beach, which, in this Alex-worthy, extended metaphor, would be the corridor outside his flat.
Which is, of course, the other thing about visiting Alex. Those Russian cigarettes.
I don’t know who supplies them, or who makes them. I’m guessing they’re secretly rolled out in Chernobyl or somewhere, a novel way of offloading waste. Because they stink. It’s the kind of spoiling, roiling, super-leafy stink you’d get if you took a flamethrower to a compost heap. With a splash of detergent to zip the whole thing up. I’d guess if I walked out of Alex’s flat and straight into an X-ray machine, you’d see noxious curls of the smoke wedged like bed springs in my bronchioles. Coughing doesn’t help. You need the respiratory equivalent of a douche.
Which is why I wasn’t keen to see Alex again.
‘I can’t believe he’s back on the books.’
‘Yeah. Well. Whaddya gonna do?’
‘What is it this time? It can’t be care. The carers hardly last a minute.’
‘I don’t know,’ sighs the coordinator. ‘He went into hospital with an AKI. They changed his meds and he self-discharged without anything. Refused to sign a non-concordance. And now he’s back home calling the ambulance every five minutes. So I think they figured they’d either refer him back to us or wheel him off the pier. And these days the pier’s fully booked.’
I have a nightmare vision of Alex as a figure on a carousel – one of those garishly painted wooden versions, all brightly coloured eyes and flaring nostrils, scattering equipment and pills and ambulance sheets as they go round and round and round.
‘Anyway, just go and see he’s okay, try to make sense of where we are now. Maybe get him to sign a non-concordance,’ says the coordinator. ‘And stamp his reward card.’
When I get there, it’s difficult to find anywhere to park. There’s a fire engine, a fire officer’s car, a rapid response ambulance car and an ambulance truck, and a small crowd of people on the pavement. I excuse my way through just as a throng of emergency officers lumber out through the lobby in hazmat suits. At first I wonder if it’s Alex, and the team are all suited up because they heard about his cigarettes. But weirdly, the patient on the stretcher is an elderly woman looking perfectly healthy, wearing a comedy, cliche-old person Astrakhan coat with a fur hat, her handbag clutched to her chest. She waves to the crowd as she emerges on the trolley. I’m surprised the crowd don’t burst into applause – but actually what they do is start moving away, somewhat disappointedly, as if what they really wanted was something more dreadful and entertaining.
It seems odd to go into the block, but there’s no reason not to and the warden is standing nodding and smiling at me.
‘Come for Alex?’ she says. ‘Good! You know where to go…’
And leaves me to it.
Alex is where he always is at the start of any visit, which is smoking one of his goddamn cigarettes over by the closed window.
‘Hello Alex!’ I say. ‘You wouldn’t mind putting your cigarette out, would you?’
‘I haven’t finished it.’
‘No, but I don’t smoke so I’d really appreciate it if you did.’
‘It’s my house.’
‘I know, but still. Thanks. That’s very kind…’ (hoping it’ll clinch the deal – which, miraculously, it does). He nips out the burning end as if he were dead-heading a rose, and rests it tenderly in the ashtray.
‘There were loads of emergency services down in the lobby,’ I say, to kickstart the meeting. ‘I was worried. I thought it might be you.’
‘Me?’ he says. ‘Why? I’m not the only person who lives here.’
‘No,’ I say. ‘That’s true. You’re not.’
And even though the next half an hour will be filled with Alex telling me everything about those lost weeks, where he’d been and what happened to him, who he talked to and how he put them right, what they wanted him to do and what he ended up doing – with much better results – and so on and so on. But instead, just for one moment, one, slender unexpected moment of silence, backgrounded by the sound of slamming ambulance doors outside, framed by the melancholic curls of smoke rising from the pinched cigarette in the ashtray next to him, Alex stares at me, and I stare back, and we don’t say a word.
I’m tempted to break the silence and say ‘Ahh! Squiddy!’ – affectionately, like the Simpsons Sea Captain when he meets his nemesis, the giant squid, again.
But I don’t.
I adjust my mask.
And the whole visit goes ahead as normal.