Rosie isn’t answering the intercom or her phone, and there’s no keysafe, so it’s a stroke of luck that at that exact moment, Frieda, the scheme manager, arrives.

Frieda is a formidable figure. Tall and broad, her thick black hair tightly pulled back and fixed with a comb, her fingers knuckled with silver rings of amethyst and turquoise. ‘Show me ID’ she says, waggling them at me.
‘Come’ she says, after comparing me with the photo.
I follow her in.
Frieda’s office is a converted broom cupboard to the side of the main entrance. There’s really only room for Frieda, a desk, a chair and a filing cabinet, and all her movements have a practiced economy. She unlocks the door with a huge bundle of keys, turns on the PC, grabs sheaves of paper out of the filing cabinet, hangs her gilet up on the back of the door, runs her finger down a wall planner – the whole time talking to me about the problem they’re having with Rosie, one of their residents.

‘It happen from last September,’ she says, slamming the filing cabinet drawer shut with a vigorous sideswipe of her hip. ‘They take her to hospital for scan of head, but she totally freak out. She thought they were going to put the machine in her, and not other way round. So. They never find out what is going on in here…’
She raps her temple twice with her mobile work phone. It makes an audible clunk.
‘For example – did you hear about budgie?’
‘What d’you mean? What budgie?’
‘Rosie have budgie bird. In cage. She love it. The budgie is a very sweet little bird if you like that kind of thing. Anyway, Rosie accidentally smother this budgie.’
‘She smothered it? How?’
‘We not sure. We think she got some idea about budgie and wrapped it up in blanket. And .. well … turns out, not such a good thing for budgie. So Rosie very upset and we had funeral and everything. I had just finish jar of coffee so we put it in that, and we bury in garden. All very nice and so on. But then she was still upset, so we got plastic budgie and put it on perch. And now she think this is still same budgie, and we even have to buy it seed, although we only pretend that part, and use same box.’
‘That’s a shame!’
‘Yes. Whole thing a shame. We’ve been trying to get this thing sorted out but the doctors never do nothing. Social workers, the mental health people, they phone up, they say this meeting will happen…. that meeting will happen … but at end of day nothing happen, and Rosie is still in her flat never eating, and seeing things, and we don’t know what to do.’
‘That’s where we come in. We’ll certainly do our best to move things along.’
‘Yes? You move things along? Well. I like that, but I believe it when I see it.’
She pushes her mask more fully over nose, and glares at me over the top of it.
‘Come,’ she says. ‘We see her now.’

She body-steers me further into the hallway, turns and locks the office door.
‘I am like jailer,’ she says, twirling the bunch of keys with her index finger through the carabiner clip. ‘Good job for you I am here. I do not think she would let you in otherwise.’

Riding up in the lift, Frieda makes a couple of calls to some other residents. She’s ruthlessly pragmatic.
‘They answer phone, hello, they still alive, good,’ she says, pressing the call off. ‘Move on.’
She tells me Rosie had bloods done the day before. I knew this because I’d checked the results on the system and everything had come back as normal. It looked as if the increasing confusion Rosie was experiencing had other, less reversible causes.
‘She’s not coping,’ says Frieda as we step out of the lift. ‘If it were not for me and Junie in flat next door buying food and getting her to eat, she would be dead by now.’
‘You are good,’ I say.
She shrugs, rattles her keys.
‘Is job,’ she says.

*

Out on floor five and Frieda sweeps down the long corridor like the spirit of the place she is, with me trailing in her wake. Midway down there’s a workman kneeling, getting ready to hang a new fire door.
‘Eric’ says Frieda. He starts, almost scuffing the hinge recess with his chisel.
‘Oh!’ he says. ‘Jesus! You made me jump.’
‘Just checking you not sleeping on job,’ she says.
‘No,no,’ says Eric, but it makes me think maybe that’s a thing with Eric.

Eventually we arrive outside Rosie’s door.
Frieda gives me a look that her mask only emphasises, then knocks, loudly, twice.
‘Rosie? Hello darling! Is Frieda, Manager.’
She swings up the bunch of keys, finds the master instantly, and unlocks the door.
‘How are you, darling? I have nurse person with me today to see how you are. Is okay to come in…?’

I follow her into a dark and narrow hallway, doors closed either side and straight ahead, with one door open to the right. We go through into a tiny sitting room with a large birdcage on a coffee table with a plastic budgie taped in the middle of the perch. There are cuddly toys everywhere: rabbits, bears, mice, a knitted woolly mammoth, all of them lined up or arranged in precarious groups on shelves, on a rocking chair, on the top of the telly, on the back and arms of the sofa, on the coffee table – and in the middle of it all, in the last, clear spot of carpet, stands Rosie, her hair wild and her eyes wide, as tiny and frail and bewildered as an embroidered mouse whose plush has rubbed and whose stuffing is lost and whose whiskers, such as they are, twitch anxiously.
‘Hello my darling!’ says Frieda. ‘Is good to see you! This is Jim. He nurse assistant from hospital or something, come to see how you are and move things along.’
I nod and wave as harmlessly as I can. Rosie flinches, blinking quickly and precisely.
‘Hello, Rosie!’ I say.

*

After winning Rosie’s trust with a round of marmalade toast and a cup of tea, she lets me take her blood pressure, temperature and so on. Despite her malnourished state, her lack of personal hygiene and the fact she threw her medication away months ago, her health is surprisingly good.
‘So you’re sleeping on the sofa?’ I say.
She nods.
‘Yes. I can’t go into the bedroom any more because of all the people in there.’
‘Oh? That’s a shame! Who are they?’
‘I don’t like to ask,’ she says. ‘I keep out of their way.’
‘Shall we have a look in there now? I’m here to protect you.’
‘Well… if you think,’ she says.

I open the door into the bedroom. A pair of heavy, red velour curtains are drawn across the opposite windows. Even though it’s a bright Spring day outside, the best the sun can do is make the curtains glow, filling the room with a deep, blood-red gloom. It seems pretty neat, though – a wide, wooden double bed made up with a patchwork quilt, a line of embroidered pillows and scatter cushions at the head end, and propped up on the pillows, a large toy rabbit.
‘What a lovely bedroom!’ I say. ‘Shame you have to sleep on the sofa. And I love the rabbit!’
‘Who’s done this…?’ says Rosie, ignoring me, going up to the rabbit and fussing round it with the pillows.
‘No wonder he’s grumpy,’ I say, but my bonhomie dies a little behind my mask, because in the hectic red shade of the room, it’s hard to dodge the feeling that the rabbit is staring straight back at me, his eyebrows lowering, as Rosie fusses and clucks around it.
‘Shall we draw the curtains?’ I say. ‘Just a little. To let in some light…?’

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?

I only realised I’d met Thaddeus before when I squeezed through the gap in the hedge and walked up the path. The entrance to his house is ridiculously narrow, with two wooden panels left and right – the left one bolted shut – a step down into a porch just big enough for one person, then a step up to a front door that can only open so far because of all the clutter. It’s such a struggle forcing my way inside, it makes me feel like a calf being born, breech, only in reverse.

The last time I’d seen Thaddeus was a couple of years ago. He’d waved to me from his armchair in the front bay window, a cheery academic in some kind of bibliographic lighthouse, surrounded by hefty works on history, art, art history, philosophy and so on. He’d been having trouble with his mobility back then – a feature of his increasing age and frailty, and the number of books lying around. As I go through into the lounge, I see that his armchair and the books are still there, the eclectic range of pictures on the walls, Frieda Kahlo, Napoleon’s retreat from Moscow, a yellowing certificate from the Sorbonne, and so on – but the man himself was gone, wheeled through to the backroom and the hospital bed newly installed there.

‘Ah!’ he says. ‘Welcome! Do come in! Lovely to see you! How are you?’
He seems lighter than before. Even his beard seems thinner, the flesh of his face pale and drawn down.
‘Do take a seat,’ he says. ‘I’m afraid you find me in rather straitened circumstances.’

I’ve come with Dipna the OT to review the use of a stand aid that’s been delivered, but it quickly becomes apparent that Thaddeus needs cleaning up, the bed changing and so on. A quick set of obs also makes the idea of anything other than bed care inadvisable. I set up a cleaning station with a trash bag, a bowl of warm soapy water, wipes, towel and barrier cream, and set to work, Dipna assisting with log-rolling as the clean advances and we figure out how to change the sheets. It’s a complex, ruthlessly practical business, but Thaddeus takes it all in good heart, maintaining a commentary of such a wide-ranging and erudite character it’s difficult to keep up. At one point, though, amongst all the French and Latin and what have you, I make out the name Dreyfus.

Sometimes, when you’re watching a quiz like ‘University Challenge’ or ‘Mastermind’, you instinctively respond to the toughest question because it hooks something out of you that you didn’t know you knew. And because you say it so confidently and naturally – like it was nothing at all, something anyone would know – it suddenly makes you look incredibly smart, even though for most of the time you’ve been watching the quiz with your mouth slack, because you’re too lazy to get up and look for the remote. And the truth is, maybe you saw the answer years ago, in an advert, maybe, or overheard it on the train, and it lodged for some reason, like those people who get shot in the war and it’s only years later when they go for an x-ray to investigate migraines and the radiographer points to the pale outline of a bullet. And maybe you have a whole mess of other scraps in there, too, a mess it would take a lifetime of quizzes, or maybe some kind of truth drug, to clean out.

The point is, Thaaddeus says Dreyfus.

‘Ah!’ I say, tossing a wipe. ‘The Dreyfus Affair!’

Thaddeus grabs my gloved hand.

‘I thought I recognised those eyes above the mask! Esterhazy! So it was you!’ he says. ‘Mon Dieu! Now I see it! You’ve been using your time travelling skills and your schmutzig Deutschmarks to foment bitterness about the world! Will you never be satisfied?’
‘C’est vrai!’ I tell him. ‘C’est moi!’

And I just hope he doesn’t expect any more French than that.