‘Just do what you can,’ Michaela the co-ordinator said. ‘It’s a tricky situation. Jeremy’s wife Serena has got dementia, Jeremy’s the main carer. The doctor says Jeremy has to go to hospital in the next few hours, something about his breathing. Apparently none of the rest of the family can step in, and Serena’s too volatile to go to a respite bed, so what they’re saying is she’ll just have to go to hospital with him in the ambulance. Which is a terrible idea, obviously. If you could just go there and try and sort something out that’d be great. You’ve got a couple of hours before the ambulance arrives. Good luck.’

* * *

When I lived in London I used to go swimming in the ponds on Hampstead heath. I’d try to keep it up as late as I could through the year, not just in the easy summer days, but on into October, November, December, when the weather drew down, and the crowds thinned, and the whole thing started to feel like a wanton act of madness to take my clothes off and walk outside the changing rooms into the frosty air, let alone walk to the end of the jetty and throw myself in the water. It didn’t matter how many times I stood there with my toes curling and flexing over the edge of the concrete, staring down into the dark green water; it didn’t matter that I’d done it only a few days before, and everything had turned out okay, I hadn’t drowned or frozen to death, and I’d even started to enjoy it, that electric buzz around my body when I climbed out and hurried back inside. Despite all that, the seconds before I dived in, I would still be gripped by the same sickening feeling that this was crazy, tantamount to suicide, and what I really needed was for someone to rush out, grab hold of me, and save me from myself.

* * *

I’m reminded of that end-of-jetty feeling as I reach out to ring Jeremy’s bell.

Anna, Serena’s tearful, middle-aged daughter, comes to the door, barely stopping long enough to hear me introduce myself before turning around and hurrying back into the living room. I stand in the oak panelled hallway and tried to get my bearings. A substantial house, with a large number of doors leading off into various rooms, and a forbidding staircase rising in the middle of it all. Elderly people are busy coming and going through the doors or walking up or down the staircase, each one of them preoccupied, mumbling or cursing to themselves, holding bits of paper or bags, a shirt, an overcoat, bumping into each other, shouting out – so many of them I’m suspicious, and wonder if it this isn’t some kind of set-up, and they’re swapping jackets or hats backstage, finding a different door or staircase to walk through or down again, like a manically paced but well choreographed West End farce.

Bracing myself, I go through to the kitchen where some of the relatives have gathered round the table with Serena at the head end. Serena has the quick movements and filmy white eyes of a large, albino crow, hopping from the table to the cabinets and back, randomly picking up bits of paper, blinking down at them uncomprehendingly, then carrying them back again.
‘Try to settle yourself, Serena’ says one relative.
‘Come on. Drink your tea,’ says another.
But Serena sees me approach and hops up to speak, as fluently as if we’d only broken off a moment before.
‘…you see, I can’t be bothered with all of this!’ she says, looking up into my face, tipping her head from side to side and blinking rapidly, as if she can’t decide whether to talk to me or peck me up like a worm. ‘It’s such a nuisance! I’ve got so much to do today. D’you see?’
‘Yes. I can imagine it must be pretty stressful.’
The relatives fix me with a collective frown.
‘Sorry! Hello! I’m Jim, from the hospital response team. They’ve asked me to come and see if there’s anything I can do.’
‘Well unless you’ve got a magic wand in that bag I’d say no,’ says one elderly man.
‘Or a tranquiliser dart,’ says another. ‘Welcome to the madhouse.’
Just then Jeremy wanders in. He’s a morose, red-faced man in pyjamas and dressing gown, trailing the cord of it behind him like a tail.
‘They’ll be here in a minute,’ he says. ‘What have you done with my medications?’
One of the relatives sighs and pushes himself up from the table. Another one appears briefly behind me in the doorway, then disappears just as quickly.
‘Come in to my study and we’ll chat there,’ says Jeremy.
I follow him, avoiding the tail.

Jeremy’s study is a plush room, like something out of a gentleman’s club, with brass fittings, spot-lit paintings, and antique rifles and muskets on display along the walls. Jeremy goes to sit behind an enormous desk, complete with green velvet pad and a crystal glass ink and pen stand.
‘You know the situation I take it?’ he says, putting some half-glasses onto the end of his nose and then tipping his back to look at me. ‘Hmm?’
‘Essentially – you have to go to hospital, but you’re Serena’s main carer and there’s no-one else to step in and look after her.’
‘And I mean no-one,’ he says. ‘She gets very distressed by any change, so it’s out of the question for her to go to a nursing home. I’ve told them this. Out of the question! And neither can she be left on her own. She’d burn the house down in a matter of minutes.’
‘How about arranging for a twenty-four hour carer?’
‘No,’ he says. ‘Any strangers in the house and she reacts. She’s very difficult. I’ve had years of it.’
‘The trouble is, Jeremy, going to hospital with you is the worst thing that can happen. You’ve been to A and E before. You know what it’s like.’
‘I know exactly what it’s like. It’s hell on earth.’
‘They do get very busy there, that’s for sure. And that’s why Serena can’t really go with you. She’ll be sitting in a chair for hours and hours whilst you’re on a trolley, surrounded by potentially distressing scenes. And there’ll always be the chance she might wander off…’
‘Well that’s it! I’m not going, then!’
‘The doctor thinks you should go, though. It won’t help Serena if you get worse, will it? So what I suggest is you look at getting a twenty-four hour carer to stay whilst you’re in hospital. They’re trained to look after difficult patients. She’ll be happiest and safest that way. It’s the best solution, Jeremy. I’m just being perfectly frank with you here.’
I can see him weakening.
‘But where would they sleep?’ he says.
‘I’m sure you could squeeze them in somewhere.’
‘And how much would it cost?’
‘I think it’s about twelve hundred for the week.’
‘One thousand two hundred pounds?’
‘I think so. It’s just a little more than a residential home would be – but you’ve got the benefit of Serena being at home in familiar surroundings, so she’ll find it much less stressful…’
He huffs and grumbles, pushing papers around on the desk a moment, then shoots me a look as directly as if he’d rammed the words into the muzzle of one of those muskets and fired them at me.
‘And who pays for all this? Me, I presume!’
‘I think it’s worth it. For peace of mind. And hopefully you won’t be in hospital long.’
‘Hmm. Well. Get me some actual figures, would you?’
‘Certainly.’

I phone the office to talk to a social worker about it. She rings me back five minutes later with the name and number of an agency who’d be able to step in at short notice.
‘I can’t pay up front,’ says Jeremy. ‘I’m good for the money as you can probably see but I’m waiting on a deal coming through. It’s complicated. A cash flow thing.’
‘Fine. I’ll talk to the manager of the agency and see what he suggests.’

The manager sounds cautious.
‘We want to help,’ he says. ‘Of course we do. But we need at least half up front as a gesture of goodwill. And then a guarantor of some description for the rest. It doesn’t look good for a care agency to be chasing down clients for money, y’know?’
‘No. I can see that.’
I tell him I’ll call him back after I’ve talked to the family. Back in the kitchen, one of them says he’ll stand for the other half. ‘ Anything to get this bloody mess sorted.’
In the study again. Jeremy says he can only manage a cheque for four hundred, and asks if I’ll haggle with the manager over that.
Meanwhile the ambulance arrives; two paramedics crash into the study carrying resus and obs bags and an ECG.
‘Where’s the patient?’ says the first.
Jeremy starts shuffling papers on his desk, avoiding eye contact.
The paramedics turn to look at me, holding the phone in the middle of the room.
Serena hops in, pursued by three relatives, one of them The Guarantor, who frowns at me and holds his hands out, palm up.
The phone starts ringing in my hand. I hold up a finger for silence.
‘Just give me a moment!’ I say. ‘One moment…’