blog robin

Well – I can’t believe another year has come and gone…

I think that’s the accepted way of starting a round robin letter, those insipid but curiously incendiary A4 slabs of family business that get smuggled inside Christmas cards like condoms of pure news inside a drugs mule.

There’s lots already been said about Round Robin letters. Simon Hoggart published a series of very funny books about them, and you’d think that would’ve been the comedic stake through the heart of the phenomenon. But they still keep coming back, and I suppose it’s because of their utilitarian nature.

I’ll admit, sometimes it feels a little curt just to put Lots of Love, Jim xx when I haven’t spoken to that person, brother or what-have-you, in six months or a year – and don’t they deserve more? So the temptation is to write a paragraph or two, and if you roll that out over a dozen or more cards it becomes quite a thing. And I’ll be saying much the same stuff. So the temptation might be to rationalise the process (I say temptation in a HIGHLY theoretical way, because, actually, I’ve never been tempted), spend a little time getting it right on the computer, a few jokes and quotes, a mixture of trips, triumphs and tragedies, tactfully balanced, nicely aligned, with a few cheeky snaps to cheer the whole thing up.

So yeah – I suppose it does make sense.

Except it doesn’t, because if you’re close enough to care about this stuff you’ll know about it already. And if you’re not, you won’t.

P1130168
ting ting ting ting ting

And by the way, if you’ve sent me one – thanks very much! It was lovely to hear all your news.

Merry Christmas & a very Happy New Year!

With lots of love

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(p.s the round robin’s in the post…)

the old dance

the fallow field
that runs down to the wood
has fallen to the clearances
including, I’m sorry to say,
one half of the badger sett
that extended from the treeline
to the flag of a lone goat willow
and an armoury of brambles.
(the flag dropped
before the tracks of the digger;
the thorns were out-toothed
by the bucket)

but badgers don’t know
the meaning of defeat
(I think it’s safe to say)
because I suppose nature
has its hard ways, too
and all you can do
is get on and survive
anyway, suffice to say,
they wasted no time
over the next couple of weeks
doing a bit of digging of their own
excavating old runs
opening new ones
reinforcing, extending, clearing
all on the woodland side
and this morning when I went
to see how they were getting on
I found slag piles slung
from a number of holes
scree slopes of sandy soil
deep-found stones, roots, sticks
and in amongst it all
the skull and hip bones of a rabbit
the femur of a badger

I wasn’t shocked
I mean, it’s been a good while since I thought
badgers were grumpy but essentially kind
reading books in high-backed chairs
carrying a candle each night to bed
and I know, intellectually at least,
that when a badger dies
or any of the other animals that share
its extensive chambers
they hold no vigil
around some other hole entirely
heads bowed, paws folded,
incanting from Thessalonians
the mourner’s kaddish
or Ṣalāt al-Janāzah
no. they get busy
with the bustling shuffleP1130078
they’ve known for years without thinking
head down into the darker earth
front paw to back
with a flick and a shuffle and a flick
out with the roots
out with the stones
out with the bones
making good the ways
making good the days
making good the sett

the plan

Stress is like bad weather. You could draw isobars on a map. Arrows indicating direction of flow. Cloud banks. Lightning.

The Out of Hours team had taken a stormy call from Graham first thing that morning. He said his mum Sara had effectively been fly-tipped back home, and the promised follow-up from our community health team scheduled for the next day was completely unacceptable.

I didn’t know anything about it, so before I picked up the phone to call Graham back I scrolled through the extensive notes on the system. They described how Sara had been admitted to hospital by ambulance with an infection, then subsequently found to have suffered an ischemic stroke. Unfortunately she still had marked problems with balance and coordination even after thrombolysis, and her speech, memory and mood were also affected. Various treatments and therapies had been started, but Sara had become distressed and unhappy on the ward. Graham attended a multi-disciplinary meeting to weigh-up the benefits of keeping Sara in hospital with the risks of sending her home. Everyone had been in agreement: the plan was to discharge on the understanding it would be bed care only for 48 hours until the community health team could assess and organise the necessary moving and handling equipment. Carers had been arranged to come in four times a day to help with all of this.

A substantial set of notes, but one that demonstrated the lengths the hospital was prepared to go to get Sara back home as safely as possible.

When finally I manage to speak to him, Graham is as cross as the Out of Hours operator had described.

‘I’m not stupid’ he snaps. ‘I know what they’re really worried about. They just want the bed. They couldn’t care less. But what they don’t seem to understand is how much my mum used to do for herself. She was an independent lady. She couldn’t bear to lie around all day. I can’t just leave her there, soiling herself in those pads. I mean – there’s nothing here for her. If I can help her to the commode I will…’

He races on barely pausing to breathe, mixing in the horrors of his mum’s current situation with anecdotes about the bridge club she went to twice a week, the dog, the twins’ birthday coming up, the state of the garden and so on. If I didn’t have the MDT summary in front of me I would never have guessed that Graham had been there at all.

As gently as I can I try to go over the plan as described in the notes. Bed care only, until the community health team can go in the next day to assess all transfers and order up the necessary equipment.
‘It’ll go in as urgent,’ I tell him. ‘We’ll work as quickly as we can.’
‘She’s an active person!’ says Graham.
‘Yes, but then – of course – she’s had this stroke…’
‘All this lying around isn’t good for anybody. She’ll get bed sores. She’ll go mad.’
‘I think the plan is to go steady and build your mum’s strength up gradually. The last thing you want is for her to fall, break something, and go straight back to hospital. It didn’t sound as if she was very happy there.’
‘She wasn’t happy.’
‘No. So look. We’ve got to take things steady and give them time to work. The carers will be coming in through the day and evening. We can organise someone in the middle of the night if that would help, too. We’ll get a therapist in to assess all the manual handling angles, see about a hospital bed and take it from there. How does that sound?’
‘I think if my mum wants to get out of bed I’m not going to sit there and do nothing. I know you don’t like it, but there you are. I’m just being honest. I know what I can and can’t do. And what I can’t do is simply sit there and put my fingers in my ears when she cries out.’

As sympathetically but as clearly as I can I go over the plan again. Graham is too stressed to take it in, though. After I put the phone down I talk it over with my colleagues. We look at the schedule but there’s nothing we can do to bring the manual handling assessment forward. The best we can do is send a nurse in to do a quick review of obs, pressure areas and a welfare check.

I give the nurse a heads-up on the situation; she thanks me with an ironic smile.
‘Why d’you always give me the difficult ones?’ she says.

*

When I see the nurse at the end of the shift I ask her how the review went.
‘Easy,’ she says.
‘Oh? Really? Wow! I’m amazed. Graham was so incredibly stressed on the phone.’
‘Well I wouldn’t know about that,’ says the nurse. ‘There was no-one in. Turns out his mum fell. She’s back in the hospital.’

I’m so gorgeous

I’m so gorgeous
a band of candy-scented unicorns
canter over with heart-shaped stickers on their horns
sweet thing / love bug / be mine
(it’s fine
they do it all the time)
I’m so gorgeous
the gauzy ghost of Rudolph Valentino vapes into shot
asks me what my secret is and for any advice I’ve got
I put my arm into the air where his shoulders should be
and share my regime confidentially
I’m so gorgeous
invertebrates prate
reptiles unravel
amphibians create
mammals babble
I’m so gorgeous
the very stars in heaven, singing in their crystalline spheres of ice
break free their shackles & hurl themselves in flaming legions at my feet (which is nice)
I’m so gorgeous
Helen of Troy
lazing on a bouffant borzoi
reading about me in Tatlers
coquettishly sucking her pearly rattlers
suddenly jumps off her ‘aris
flips her ol’ man paris
a richly be-ringed bird
rushes outside without another word
leaps on her chariot
texts me to meet her in some seedy Marriott
(she’s okay, Helen, despite the hype
but not really what you’d call my type)
I’m so gorgeous
the Egyptian god Horus
leads an apocalyptic chorus
scorches the sky with a terrifying sound
tearing the sea, ripping the burned ground
commanding all existence to do as I bid
& asks where I’d like my pyramid
(I thank him for the fealty
graciously decline the realty)
I’m so gorgeous
I spend many happy hours in the contemplation
of the perfection of my own reflection
although – at the risk of sounding vain –
this whole gorgeousness thing can be a pain
and I think to myself, God, what I wouldn’t give
for the life the rest of you losers live

sad eyed lurcher of the lowlands

It was the dog that brought it back.

I had a sudden and vivid picture of the granddaughter’s English Lurcher, slowly lifting its head out of my bag when I went to fetch my steth. A mournful expression, like it had seen what I had in there and was profoundly disappointed.

As soon as I remembered the dog I had the whole scenario, in every detail: the carers who’d said Edie was off her legs and stuck in the chair; the GP who’d diagnosed an exacerbation of chronic shoulder pain, and prescribed stronger analgesia, referring Edie to us for physio, nursing, equipment, bridging care and whatever else we could think of; Edie herself, slumped over in a high-backed chair watching The Chase on TV; the granddaughter; the dog.

More than anything I remembered how successful the visit had been.

I’d met up with Jason for the double-up. Her obs had been fine, but because of her shoulder pain she’d struggled to push herself up from the chair. The longer she stayed scrunched up like that, the less likely she was to move, until she’d pretty much seized up completely. For a while it had looked as if Edie might have to go to hospital, but with patience, encouragement and some delicate handling, we’d managed to get Edie out of the chair and moving again. We’d put her to bed where she’d be able to rest in a more appropriate position, and mobilise more readily to a commode. It was all fine. The carers would be coming in as before. The stronger meds would ease things along, and a programme of physiotherapy would help Edie recover her strength and confidence. All in all, a very practical and successful intervention.

Which is why I couldn’t understand why Jason was talking about a complaint.

It had come from the daughter, who lived some miles away. Her view was that her mother should have been taken to hospital, or at the very least been given a bed in a rehab facility. According to the daughter we had failed in our duty of care. She had written to her MP. We had a day to write a statement.

‘It’s okay,’ said Jason with a shrug. ‘I don’t think the daughter really understands how things are with her mum. Who knows what the family dynamic is there? Maybe she heard stuck in chair and thought hospital? Never mind. It’ll be fine. We did the right thing.’

I felt aggrieved on Jason’s behalf. I’ve known him ever since I joined the team. An expert physio, he was friendly, positive, empathetic – in fact, a perfect example of what a community therapist should be. I could see him now, taking the whole situation in, crouching beside Edie, one hand on hers, patiently going over the options, how we could help, what we could try. No-one could have done more, and – I don’t think – could have produced such good results. All this at the end of a long and gruelling day. The injustice was crushing.

Jason slapped me on the shoulder and smiled.
‘Cheer up, Jim!’ he said. ‘You remind me of that dog!’

I’m so ugly

I’m so ugly
The King & Queen of Dreadful sent me an official letter
requesting the pleasure of my company to make them look better
I’m so ugly
The Royal College of Aberration threatened to eject my sorry ass
unless I agreed to sign a formal declaration and wear a mask
I’m so ugly
I had a potato named after me
(quickly renamed after an outcry from the PMB
who said I was dragging spuds
through the muds)
I’m so ugly
a hideous dragon sobbed when it saw me advance
snorting ‘Sheesh! I wondered why you weren’t carrying a lance…’
I’m so ugly
When I look in the mirror it flips
& when I sit down to draw my face the paper rips
bawls, hurls itself into the bin
rather than bear the agony of that vile profile again
I’m so ugly
I teach Ungainliness & Abhorrence
At the Royal Academy for Awfulness & Aesthetic Sinning in Florence
I’m so ugly
I get handsomely paid to sit on the front rows
of all the best squawk, talk and funny walk shows
where the producers prize
my floundery eyes
my sense of funk
my squalid junk
my scabrous trunk
my sick sense
my leathery vents
I’m so ugly
YOU hurt
I’m so ugly
you curtsy
because as far as you can see
anyone touched by such monstrosity
must surely be some kind of royalty
*sigh*
I like my hands thoughugly

my week

Monday started out not too bad
like a teacup ride, to be fair
gigantic, plastic, embarrassingly slow
me with an expression like a hook-a-duck
gliding around with badly painted eyes
in a haze of burned sugar and bad language
Tuesday I hung for a while
a cheap, flammable lemur with velcro paws
waiting for a darted card in the freezing rain
whilst the pandas and the purple elephants
swung smug, happily asphyxiating in bags
Wednesday was like a ghost train
woohs & oh gods and waaah-ha-haaas
bent mirrors, skeletons in rocking chairs
and then, at a jarring tuck of the rail
someone bored in a claw
leaning out to scraggle my hair
Thursday was horrifying, a pendulum cage
a scream, a grimace, a scattering of vomit
like floss flavoured incense flung from a censer
Friday was classic. Friday was the waltzers
hurled into the trough of a wave
by a bandit prince with a fag in his grin
vaulting pole to pole, making it worse
whilst the waltzer king watched with doomed approvalBumper Cars
from his hub of bulbs and mirrors
Saturday was bumper cars
fucking pointless if you ask me
Sunday I stayed in
yep shit all in all
an emotional rollercoaster

ergonomics

No-one wants to be here, on the Bi-Annual Patient Handling course today. No-one. And – to be fair – the Trust probably don’t want us here, either. I’m sure if they could cover their legal obligations some other way, by hiring someone in a crop-duster to swoop in low every once in a while to spray the county with liquefied rules and regs, or maybe introduce it into the water like fluoride, they undoubtedly would. But as neither of those things are currently an option, here we are on a business park on the furthest, most westerly edge of the county – so far west, I wouldn’t be surprised to see cars and buses plummeting off the edge of the world, beeping their horns, revving helplessly, as they tumbled away into infinity.

Nothing so wonderful. Here we sit in a brave and chippy semicircle, introducing ourselves.

Our tutor Pawel is as upbeat as we are cynical. He says ‘Hello’ very emphatically when it’s our turn to speak, leaning forwards and pyramiding his hands beneath his nose, like this is the most fascinating bunch of people it’s ever been his pleasure to meet. And when each of us is done speaking our sad little bio, he says ‘Welcome’ very sincerely, almost tenderly, acknowledging our bravery and honesty, and then moves on to the next.

He’s dressed in a dark blue polo shirt, combat trousers and black boots, the partisan captain of an evangelical Occupational Health outreach unit, a visionary zeal about him that his Polish accent somehow intensifies.

Pawel can hardly wait for the introductions to finish before he strides about the room. Even the housekeeping at the beginning reads more like the opening of a thriller.

‘And God forbid there should ever be a FIRE! – Don’t worry, my friends! I’m not planning for this to happen! But if there IS A FIRE! – You should all follow me through the main offices here, and I will lead you to SAFETY in the corner of the parking lot…’

We start the training. Pawel pegs out a line of awful statistics about back pain and so on, the costs to the service, the cost to the practitioners, and then moves onto all the techniques that will protect us from this. We take it in turns to be the patient, effortlessly moved up and down the hospital bed, from chair to chair, from floor to chair, from chair to floor to chair, each time Pawel snapping his red nylon slide sheet like a magician, stuffing it into tiny gaps, whipping it out again. Frictionless movement. Painless transfers. Safety. Comfort. ERGONOMICS.

‘Do you SEE it?’ he says after every procedure. ‘Do you SEE it?’

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a clean decision

At the barber’s for a haircut. Luckily there’s only one person ahead of me, a large, silver haired man with huge red ears and a booming voice.
‘Oh yes, I was a referee for fifty years,’ he says.
‘It’s not something I could do,’ says the barber, gently combing the strands around, snipping the ends. ‘I don’t have the temperament.’
‘Nonsense!’ says the man. ‘Although I’ll admit you do have to have a measure of control. The players can become quite – how shall I put it? – excited about your decisions, and you have to exercise a certain amount of diplomacy and common sense.’
‘I bet you do,’ says the barber.
‘Take swearing, for instance. Now – I fully understand that in the rough and tumble of play you can forget where you are and say this or that and turn the air blue. But I was always very clear. And when the captains came together to toss the coin, I would say to them: You know me, gentlemen. I am perfectly fine with a little rough language now and again, but if there’s one word directed straight at me it’ll be out with the red card and off you go. I earned quite a reputation.’
‘I bet you did’ says the barber. ‘How much off the top?’
‘Oh – do what you can with the bald patch. I’m not expecting miracles.’
‘Right you are.’
‘I remember one particular match. It was a local derby, very heated. Quite a bit of needle between the players. Towards the end one of them went in for a particularly positive tackle and his opponent took a tumble. But it was clear to me that he’d played the ball and not the player, and as such there had been no infringement of the rules. The next thing I knew the captain came running up and he said Where’s our penalty, ref? So I explained to him why it didn’t warrant one, and signalled for play to continue. Unfortunately the poor chap couldn’t help himself. You’re a fucking idiot he said, straight to my face.’
‘He didn’t!’
‘I’m afraid so.’
‘What did you do?’
‘Well – what d’you think I did? I said to him: Oh? So I’m a fucking idiot, am I? Well – d’you know what this is? That’s right! It’s a red card. And d’you know why I’m showing it to you? Because you are out of this game, mister! I bid you good day!’
‘Eyebrows?’
‘What’s that?’
‘Eyebrows. D’you want me to do your eyebrows?’
‘Oh. Yes. Well. Could you? They’re getting a bit wild.’

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lola, the robot & the ball

It was only a matter of time.

When it’s my day off I’ll take Lola on her walk about the same time each morning. And because we’re regular we tend to meet the same people. I quite often see the elderly woman and her Jack Russell on the way back from the woods. She’s particularly distinctive, in a large, shovel-style hat and long quilted coat, bent forwards at the waist, carrying a tennis racket behind her, marching along in such a chaotic but determined way that from a distance the tennis racket looks like a key in the back of a giant clockwork robot. Now and again she’ll stop to pick up a squeaky yellow ball, and then using the tennis racket it whack it half way across the park for the Jack Russell to tear after. I try to anticipate seeing them, because Lola has an embarrassing habit of stealing other dogs’ toys and then running round and round in a celebratory lap that only gets bigger and faster the more you try to stop it. In fact, the only way I’ve found to get the ball back is to pretend I’ve found something even more interesting. (And I love Lola very much, but even I would have to admit that this is one powerful argument against the idea that Lola is a Very Intelligent Dog, because surely if she were, she wouldn’t keep falling for it).

Anyway – today I wasn’t quick enough. Before I could think to do anything, Lola had run straight across the park, intercepted the ball, and started lapping us all, squeaking the ball every time she passed, like a sprinter marking split-times. I waved and mimed an extravagant apology to the old woman, whilst moving into position to try the ‘Look what I’ve got’ trick again. The old woman ignored me, though. She was too busy making things worse by marching in a furiously ineffectual pattern, waving her tennis racket and hollering. Meanwhile, her Jack Russell had retreated to the path, where it sat with its muzzle on its paws looking thoroughly depressed, like its worst fears had been realised, and nothing would ever be the same again.

‘Don’t worry! I’ll get your ball back!’ I shouted.

It wasn’t easy. Every time Lola looked as if, maybe, this time, against all the odds, I might actually have something of genuine interest, the old woman would make ground on her, and set her off squeaking again.

Suddenly the old woman changed her trajectory, marching straight for me, either because she thought she’d have more luck whacking Lola if she stood next to me, or because she thought she might start whacking me, and bring Lola over that way. But when the old woman came within earshot it was obvious she was too out of breath to say or do anything, so I seized my chance.

‘Lola! Wow! Look at this! Unbelievable…!’ I said, bending down and pretending to find something incredible in the grass.

It worked. I could hear the squeaks getting louder.
I looked up.
Lola had stopped just beyond the distance she and I both knew I could cover in a standing leap, had dropped the ball onto the grass in front of her, and was standing there, panting and smiling at me, as if to say: Okay. What? What have you got?
Pathetically, I held out a leaf.
‘Here you are, Lola! Good girl! Look at this! Wow! Good girl!’
Incredibly, she inched a little closer.
Well. That’s just a leaf, isn’t it?
I sniffed the leaf and held it up to the light.
‘Fantastic! This is amazing!’
She came a little closer. Glanced back at the ball. A little closer.
Fatally close.
I leapt forward, grabbed her collar, clipped on the lead. Gave her a hug and a pat. Retrieved the ball and held it up for the old woman to see.
‘Don’t – whatever you do – throw it!’ she gasped.

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