‘Oh. I thought you were the fish man.’
‘The fish man?’
‘Come to clean the tank.’
‘No. I’m from the hospital. Come to see how you are.’
Vera backs up, and lets me in to the narrow hallway. There are two doors to the left, and behind her, a steep set of stairs leading up to the maisonette. The chair to Vera’s stair-lift is waiting for her where she left it.
‘Sorry it took so long to answer the door,’ she says, carefully climbing back onto it. ‘That’s why I put that notice on the door. Right! Here we go!’
And ignoring the seat belt, she flicks the switch and begins the slow journey up.
‘I think you’ve got that about right,’ I say, following on behind, ‘…getting someone in to clean the tank. It’s such a chore. I remember when the girls were small and they insisted we got some fish. Guess who ended up soaked to his elbows in dirty water every weekend.’
‘I know. It is a bit of a job. John used to do it when he was alive, but I don’t have the knack. Or the patience, to be honest.’
‘Hamsters, too. I don’t see the point of hamsters. They only come out at night.’
‘But they’ve got such funny little faces, haven’t they?’
She peers down at me, pursing her lips and raising her eyebrows.
‘Well. Yes. That’s true.’
At the top of the stairs she raises the handle and steps onto the landing.
‘This way,’ she says.
I follow her into the sitting room, one whole side of which is entirely given over to an enormous aquarium, rounded at one end like the prow of a ship, the base meticulously crafted in burr walnut, the tank itself a faithful recreation of a coral reef, with gently undulating plants, and a circulating crowd of exotic fins.
‘Wow! When you said tank I thought you meant a goldfish or two.’
‘It was John’s thing, really. But I like to see them lit up at night, swimming about. I find it quite comforting. D’you see?’
The doorbell rings downstairs.
‘That’ll be him,’ she says. ‘That’ll be the fish man. Would you mind popping down and showing him in? Only I’m worried by the time I make it down again he’ll have thrown his buckets in the van and gone home.’

Mr Cooper looks dead, hunched over in his armchair, his dressing gown gaping, his wasted chest waxy in the meagre light filtering through the curtains.
‘Mr Cooper?’
I flip the bakelite switch on the wall, which fizzes and snits with blue sparks.
‘Shit.’
I flip it off again.
Mr Cooper makes no movement. The only sound in the room is from the gas fire, purring gently next to him.
‘Hello?’
I go over to him and crouch down, placing a hand on his arm.
‘Mr Cooper?’
He nods, and opens one eye.
‘What is it? Why don’t you go back to sleep?’
‘Mr Cooper – it’s Jim, from the hospital. I’ve come to see how you are.’
He closes his eye again.
‘Mr Cooper…?’

Even if I hadn’t been here several times in the last few months, I’d know he’d been on our books before. There’s a perching stool over in the corner, buried beneath a pile of junk; a pressure relieving cushion and a walking frame dumped on the unused bed along with a mountain of discarded clothes and bags of assorted creams and bandages, and through the open door to the adjoining bathroom, a bath-board acting as an extemporary shelf for a stack of buckets, boxes and blister packs of medication. There’s been a marked deterioration, though. The flat was always a mess, but in the six months since I was last here it has slumped into something worse. The only signs of clarity, of humanity, are an emergency shop in a cleared space in his filthy little kitchen, the barest essentials to keep a person going, and by the side of his armchair, a green drugs bag with his TTOs, discharge summary, and a DNACPR in a clear plastic folder, neatly signed and dated.

Because, of course, the difficulty with Mr Cooper is, well, Mr Cooper.

It had always been an uphill struggle to get him to agree to anything. A little shopping from time to time, the barest minimum of wound care, the occasional knock on the door – these were only ever achieved in the face of his unrelenting refusal to accept help. The dangers had been explained, of course, with sufficient checks to show that yes, Mr Cooper did have mental capacity to make these decisions. And the result was that despite everyone’s best efforts, over the months and years the scenario had played out with a cruelly inevitable decline. The best any of us could ever do was try not to lose touch completely.

Like a sly, slow-moving, community health chameleon, I try to persuade Mr Cooper to let me take a few observations. Still, it’s more a testament to his failing health than any social skill of mine that he agrees to the barest minimum, and lets me put some barrier cream on his sore areas.
‘There!’ I say, peeling off my gloves. ‘That’ll be a little more comfortable.’
The readings aren’t good, though. And my luck certainly doesn’t stretch to an ambulance.
‘Hmm. I must admit I’m worried about you, Mr Cooper.’
He starts in the chair, as if someone had given his wasted shoulders a gentle shake, then he slumps back into his mausoleum-grade torpor.
‘Just go to sleep,’ he says.
It sounds as if he’s talking to a naughty child, and for a minute I wonder if it’s a sign of increased confusion. If it was, his capacity would be compromised and I could get him forcibly admitted. But as soon as I explore that option, it becomes apparent that it’s just a figure of speech. He’s referring to himself in the third person. He knows exactly what he’s about.
I explain to him as clearly as I can why I’m worried, why I’d like to re-admit him to hospital, and what might happen if he doesn’t go.
‘No,’ he says. ‘Thank you.’
There’s nothing more to be done.
I put some food and water by his chair, move the commode a little closer, and let myself out.
After I’ve put the key back in the keysafe, I phone the office and let them know how things stand, my concerns about the faulty light switch, the gas fire, the environment, the whole dismal scenario.
‘Sounds depressingly familiar,’ says Michaela. ‘I’ll get the council on to the electrics. In the meantime – Jim – I’ve got another job for you…’

*

Later that day I’m asked to go back to Mr Cooper for a welfare check.
It’s completely dark when I let myself into the flat. I don’t want to use any of the light switches, so get out my torch.
‘Hello? Mr Cooper…?’
I train the beam on his armchair.
Empty.
‘Hello…?’
It’s strange, how different the place is by torch light. I hadn’t noticed that behind his armchair is a workbench, with vices, a scattering of fine tools, and a dismantled model train.
‘Mr Cooper…? It’s Jim, from the hospital…’
Two rooms I’d not been in before. One filled floor to ceiling with books, the other with metal shelving, neatly lined with old glass storage jars, their yellowing contents indistinguishable behind a coating of dust.
‘Mr Cooper…?’
But the flat is empty.

Going back to the front room, I notice for the first time that Mr Cooper’s emergency button has been unfastened and draped neatly over the back of his chair. Seeing it there, isolated like that, in the direct light of the torch, that precise circle of red in its plastic ellipse, talismanic, an upturned eye, it’s easy to think that after all those years of resisting and signing forms and saying no and just go to sleep and please leave – the very instant Mr Cooper gave in and pressed the magic button, without any further hesitation or debate about the matter, he completely and instantly vanished.
And that was the end of the matter.

David is in bed – has been, for the last few weeks – a slow, ineluctable decline. He’s got everything he needs, though, as many adaptations and pieces of equipment as the little bedroom will accommodate. There’s really little else to be done. His wife Sara shows me through, then hurries back into the lounge to answer the phone. David holds out his hand. We shake.
‘Thank you for coming,’ he says. ‘It’s all a bit of a how-de-do.’
David and Sara are both artists. The flat is filled with their paintings and those of their contemporaries. Pride of place on the wall immediately above David is a small, full length, black and white photograph of Sara, taken back in the fifties, I would guess. She’s dressed in overalls and a headscarf, turning to smile at the camera from the easel she’s working on.
‘Of course, I’m dying,’ he says, placing his hands across his chest, by way of illustration.
‘I’m very sorry to hear it,’ I tell him.
He holds the position for a moment, then parts his hands and holds them out to the side, like the effigy on the tomb of the unknown stand-up suddenly coming to life to make one last joke. ‘Not as sorry as me,’ he says. ‘But you know what?’
‘What?’
He struggles to push himself up into more of a sitting position. I give him a hand, and re-arrange the pillows. When he’s settled and recovered his breath, he says:
‘I’m not afraid of death.’
‘No?’
‘No. And you know why?’
‘Go on.’
‘The way I see it, death is just like going back to how you were before you were born.’
‘I suppose so. That’s a nice way of looking at it.’
‘You think so?’
‘Yeah. I do.’
He laughs, pushes his fringe back in a boyish way, and then looks at me with a wide and gummy grin. ‘It’s the getting there that worries me.’

When I eventually find the place – a shambling Victorian pile on a tributary tuck of the main street, denuded limbs of Virginia creeper sweeping up over the porch and across the roof, flowerbeds overrun with weeds and yellowing grass, ancient roses fighting up through the tangle – it feels like the place is under a spell, and it’s an act of wild optimism to reach out and ring the bell. But it does ring, incredibly, sounding somewhere off in the distance, years away, and when Catherine eventually opens the door, it wouldn’t surprise me to see her dressed in crinoline.
‘Yes?’ she says.
I introduce myself.
‘And you’ve come to see William?’ she says, after a pause that her grey eyes hold for a worrying length of time. ‘What for?’
‘To see how he’s doing. His blood pressure, temperature and so on.’
She stares at me.
‘But you came round this morning.’
‘Ah – no. That was the physiotherapist.’
‘And now you want to see him?’
‘Yes, please. I won’t keep you long.’
She sighs, lets go of the door and walks away. Taking that as an invitation, I wipe my shoes on the mat and follow her inside.

William is standing in the middle of a cavernous room, irritably shuffling through the piles of newspapers and letters strewn across the dining-room table.
‘Where is it?’ he says. ‘What have you done with it?’
‘Done with what, darling?’ says Catherine.
‘You know perfectly well. The thingy. The remote control. For the television.’
‘Isn’t it by your chair?’
‘If it was by my chair why would I be asking you about it?’
‘I don’t know. Because if I did do anything with the remote control I’d have put it by your chair.’
‘But it’s not there.’
‘Well where is it, then?’
‘That’s what I’m trying to find out.’
‘What are you asking me?’
‘Because you were the last one to use it.’
‘Was I?’
‘Yes! You turned the television off when you went to bed.’
‘Did I?’
‘Yes!’
Catherine mumbles something then goes over to the sofa to start looking. She picks up magazines, moves books, gives the cushions a thump, gets distracted by that, and starts tidying up in a desultory kind of way.
I put my bag down to help.
There are a stack of remote controls under the television, but it turns out the stack is a remote control graveyard; none of them have batteries.
I carry on looking.
‘Maybe you still had it in your hand when you went through to the bedroom?’ I say, then go out of the room to check. And there it is, on the table between the two beds, along with a glass of stale water and an alarm clock.
I take it back in to the sitting room, and hand it to William.
‘Thank you!’ he says, reverently holding out both hands to take it, then hobbling straight back to his riser-recliner. As soon as he’s settled in, he powers up the TV, and then placing the remote carefully in the pocket of his chair, smiles at me and says: ‘For that I will agree to any of your requests.’
‘Well done all!’ says Catherine, smoothing down her skirt and then quickly resuming the position on the sofa I would guess she was in when I rang the bell. ‘I told you it would be in the bedroom.’

There’s a sudden roar from the TV. It’s the Rugby League championships, Wigan Warriors versus the Cronulla Sharks. I expected William or Catherine to change channels, but it looks like they’re both as keen as each other to watch the match, instantly absorbed, responding with scandalised tuts and ohs! when anything happens. It’s a bizarre contrast between the images on the screen – sharp, super-fit, super-aggressive – and the derelict, grandiose but somewhat down-at-heel atmosphere in the house.
I wonder how much hard contact sport they watch together, and whether it helps.

Luckily, it’s half-time. William and Catherine’s interest in the game doesn’t extend to the commentary, so I seize the moment.
‘Is this a good time to get that sample of urine?’ I say to William, waving a grey, papier mache bowl in the air. ‘Look! I’ll put this in the pan, and all you’ll need to do is sit and go as normal. Just don’t flush! And then if you leave it where it is, I can dip it and see if you have a urine infection. Okay?’
He seems happy with that.
I offer to help him walk through, but he flaps his hands for me to go on ahead.

The toilet looks to be an original fixture: an iron and porcelain affair, with a long chain hanging from the cistern, terminating in a black, coffin-shaped mahogany handle. Down in the water are two perfectly formed stools, as round and buoyant as net floats. I pull the chain, there’s a tumultuous rush of water, flashes of brown through the foam.
The water settles, and there they are.
‘Oh,’ says Catherine, peering over my shoulder. ‘What have you found?’
‘I just need to flush these characters away.’
‘What on earth are they?’
‘Faeces. Poo. You know. They’re just a little bit – floaty.’
‘Floaty? Well where have they come from?’
I pull the chain again. With another, cataclysmic clonking and crashing, the pan floods once more, a white-water rapid of a flush – but still, through it all, riding the plumes like two plucky kayakers…
‘I need a bucket,’ I say, as the water subsides.
‘A bucket? What on earth for?’
‘To supplement the flush.’
Catherine directs me to one in the kitchen. I fill it with water, and then carry it back through to the toilet.
‘Watch this!’ I say, pulling the chain, whilst at the same time emptying the bucket of water into the pan. Nothing could possibly survive such an onslaught – we’re hardly safe standing here like this – except… there! … as the water settles… impossible! The two floating stools.
‘Ah,’ says Catherine, peering over my shoulder. ‘Now what?’

I hold the lift door for an elderly man who hurries into the lobby waving his newspaper. After thanking me profusely and asking for the tenth floor, he stands to one side giving me significant smiles and nods, making it abundantly clear he’d like to know who it is I’ve come to visit. It’s not a huge leap of intuition to think I’m a health visitor, carrying a zimmer frame, rucksack, little black diary, with a pen stuck sideways in my lapel and an ID badge hanging on a lanyard clipped to my pocket.
‘Lovely morning,’ he says.
‘Absolutely beautiful.’
The numbers count up.
He breaks by the fifth.
‘How’s Ben?’ he says.
‘Ah! I don’t know. I haven’t actually met him yet. Are you a – relative?’
‘I’ve known Ben for years. We’re all quite worried about him, y’know. He seems to have taken a bit of a … erm… dip.’
‘I’ll see how he is today.’
‘Great! And he’ll definitely be needing that,’ he says, tapping the zimmer with his newspaper. ‘And some lead boots.’
The lift judders to a halt.
‘He’s been falling down a lot, y’see?’ says the man.
‘Oh. Yes.’
‘If there’s anything I can do…’ he says, and then waving his newspaper in the air again, strides out of the lift.

*

When Ben finally answers the door his trousers are at half-mast.
‘You wouldn’t think to look at me that I got up at five this morning,’ he says as I help to set him straight. ‘It took me two hours just to get this damned shirt buttoned.’
The contrast between Ben and his flat is so marked it’s hard to resist the idea that he’s wandered in by mistake. Whilst his clothes are stained and chaotic, his physical bearing shot, cruelly broken-down, the flat is immaculate, the hallway lined with beautiful engravings, the bookshelves neatly populated with books on opera, fine art and travel. I help him back into the living room and into his riser-recliner. The delicate ceramic vases arranged on the window ledge glow in the early morning sunshine, as does the half-empty bottle of brandy and the cut-crystal tumbler beside it, noticeably within reach of his chair.
‘The doctor and I reached an understanding many years ago,’ he says, when he catches me looking. ‘I won’t mention the drinking if he won’t ask.’
Some things speak more eloquently than words, though. Like the shaking hands, the liverish complexion, and the stitches bunched in a ragged line at the back of his head, testament to the fall he suffered a couple of days ago.
‘How are you feeling?’ I ask, setting out my gear and skimming his notes.
‘Exhausted, out of sorts. The usual.’
I’ve  been asked to include a set of neuro obs as well as everything else, just to make sure he hasn’t developed a bleed since he was discharged. He seems reassuringly intact, though. And if his blood pressure is a little low, it’s not surprising given his meagre weight, and certainly everything else is okay. I’m just putting the finishing touches to his chart when he asks for my opinion on something.
‘This chair,’ he says, leaning forwards and rubbing the armrests. ‘What do you think? Anything strike you as odd?’
I move closer.
‘No? Not really…. is there a mark there?’
‘Can you see all the words?’
‘The words? No. Can you?’
‘Look!’ he says, tracing the weave of the material with a trembling finger. ‘The whole thing is made out of auction catalogues.’
‘Is it your eyesight, do you think?’
‘There’s nothing wrong with my eyes, Jim. I can see perfectly well. No – this chair has been made out of catalogues. I’ve been trying to figure out exactly what’s on offer, but I can’t quite make it out.’
‘Who do you think made the chair?’
He straightens. ‘Well!’ he says. ‘It wasn’t me, that’s for certain.’
‘Who was it then?’
‘I don’t know. The ghosts?’
‘What ghosts?’
‘The ghosts that come and go. Mostly go.’
‘Have you been seeing them long?’
‘No. Just recently. I have to say – it’s been an odd kind of week. I saw my mother last night. The first time in thirty years. She died in the eighties, you see. She was standing at the end of the hallway, tending the roses in the garden.’
‘The garden at the end of your hall?’
‘Yes. It’s not there now, of course.’
‘Were you frightened?’
‘It was nice to see her. I called out her name, and she turned her head like this… as if she could hear me… but I don’t think she could. She just looked rather lost. And then she melted away.’
He relaxes back in the chair, hooks one thin leg over the other, and folds his hands.
‘And I’ve been having such dreams,’ he says.
‘What sort of dreams?’
‘Oh. You know. Busy dreams. Doing dreams. But the trouble is, I’m never quite sure what it is I’m supposed to be doing. Or even whether I’m the person supposed to be doing it.’
He turns his eyes on me, his moustache exaggerating the vertiginous droop of his face.
‘I suppose it’s too early for a snifter?’ he says.

Before my last visit I’d stopped to look up Connie’s hospital number on the patient database. When I entered her date of birth, twenty or so names came up. I could immediately see which was Connie, because her name was the only one not greyed-out, the only one with a blank space in the Date of Death column. Sometimes it helps to see these things laid out in a simple graphical representation.

Connie was very old.

She’d been looking better that day. She was out of bed, sitting in an armchair in the sun, a half-eaten pineapple jelly on the table beside her.
‘You’re up!’ I say as I come in to the room. ‘Wow! That’s fantastic!’
‘Is it?’ she pants. ‘I wouldn’t know.’
But it was fantastic, in the truest sense of the word. Because only in the most fanciful story could you expect a person of ninety-eight, skeletonised, wracked by chest infection and organ failure, bumping along on a blood pressure of seventy on forty – only in the realms of fiction would such a person make it out of bed and across the room to the chair in the sunny spot by the window.
‘Great! That means I can put the pressure mattress on and not disturb you.’
‘Don’t you go messing up my things,’ she said, finding the wherewithal to flash me a look. Then muttering something unintelligible, she laced her bony fingers across her belly again, closed her eyes, and went back to sleep.

A couple of days later I asked the Co-ordinator how she was getting on.
‘Connie? No – Sorry! She died in A and E.’
‘Really? Oh.’
‘Fraid so.’

I was shocked. Not that she’d died, of course – anyone could’ve told you Connie was fading. But in hospital? It felt like a failure. Whilst it was true that we’d all followed procedure, forging ahead with all the nursing, occupational and physiotherapy reviews, with all the blood tests, observations, urine dips, weight checks, and sent in any equipment we thought might help; whilst it was true that we’d been careful to make sure she had the additional carers she needed, and that the necessary referrals had been made to the District Nurse teams to monitor in the longer term, still, in spite of all this fuss – a fuss Connie hated, of course –  at the end of it all she’d been hauled off to hospital and died on a trolley in A and E.

Some of it was down to poor communication, a difference of opinion with Connie’s son, Don. He wanted to take his mum out of the sheltered accommodation and moved to a care home near him, hundreds of miles away, the other end of the country. Connie had repeatedly said she didn’t want to go. Don said she’d told him on the phone she did. By this point it was difficult to know either way. There were several reported conversations with clinicians, but nothing was signed, nothing official. And now Connie was an unreliable witness due to her failing health, and it had to be said, for other, less obvious reasons, so was Don.

The Scheme Manager was bracingly clear, though.

‘Why he’s suddenly so interested, I don’t know,’ she said, carefully shutting the office door behind me and speaking in a scandalised, lip-sticky whisper. ‘He’s had precious little to do with Connie up to now. I don’t think there’s anyone here could tell you who he was if he stuck his head round the door. But yesterday when he rang I said to him, I said Don, love! Don’t. The move’ll kill her. He didn’t like that, but there you are. What else can I say but how I see it? Connie’s happy here. She’s warm, she’s comfortable, she’s surrounded by friends, and we can all keep an eye on her and make sure she’s got everything she needs. If she makes a hundred that’ll be absolutely bloody marvellous and we’ll have a big party, but…. well… anyway. You get my drift.’

But those ninety-eight years were made up of weeks and days, hours and minutes, and it was just a fact that as they ran their course, out to the end, no-one managed to be clear about what was happening, to lay things out as neatly as Connie had laid out the things she wanted on the bed around her: an old stuffed rabbit, a speaking book, a handbag, a box of hankies, and a silent, big-buttoned, clear-faced clock.

It’s a training day. I’ve been sent to a rehab unit to learn how to give sub-cut injections of Tinzaparin, so I can add it to my roster of skills in the community. It’s all gone pretty well. Sara’s a good teacher, exacting but humane, giving me the space to practise whilst maintaining control. I like spending time with her. She inspires confidence, and the patients instinctively trust her.

She knocks on the next door on the list, and when the patient answers we both go in.
‘Good morning, Mr Templeton! My name’s Sara and I’m an Advanced Nurse Practitioner. Jim’s a nursing assistant and I’m teaching him how to give Tinzaparin injections. He’s done lots already, but he just needs one or two more. I wondered if it would be okay if he gave you your injection today?’
‘You?’ says Mr Templeton, frowning.
‘Yep’ I say, clutching my sharps bin in front of me, a little self-consciously, like a charity collector standing outside a supermarket.
‘Why? Why not me?’
‘You just don’t seem the type.’
He sniffs, and starts fussing with the things on his over-bed tray, looking up with a start when I say something else.
‘What type do I seem?’
‘Hmm?’
‘What type do I seem, Mr Templeton?’
‘Oh, I don’t know. A tad rough and ready. Builder, perhaps?’
‘Well – it’s true – I have done some building work in the past…’
‘And this is the one you think should give me an injection? In my abdomen?’ he asks Sara.
‘Yes. Would that be okay?’
He turns to look at me again, his thick eyebrows quivering with alarm.
‘It’s not like knocking down some chimney, y’know?’
‘No.’
‘Or sweeping the yard.’
‘You’d think.’
‘There’s a bit more to it than that.’
‘Absolutely.’
‘So you’ll be gentle?’
‘I will. I promise.’ I put the sharps bin on the table. ‘And if you feel anything, I’ll give you a hefty discount.’
‘A what?’
‘I say I’ll do my best.’
‘Very well, then,’ he says, relaxing back into his pillows. ‘I give my consent.’
We run through the procedure again, ensuring the medication chart is properly authorised, has all the necessary details filled in, the dosage, route, start and end dates and so on.
‘Okay, Mr Templeton.’
‘Please. Call me Harry.’
‘Okay, Harry. This is the bit where I check that we’ve got the right patient. So – can I ask you to give me your full name and date of birth, please?’
‘Ah! Name, rank and serial number, is it?’
‘If you’d be so good.’
He tells me, then gives a little salute.
‘Carry on, Corporal,’ he says, and squeezing his eyes shut, slowly raises the top of his Minion-print pyjamas.

The giant palm at the far end of the room is the only thing in the house you could say was doing well. In fact, I’d have to say that everything here – the ancient brother and sister, the piles of mouldering junk, the curling wallpaper, the pendant cobwebs, the meagre coals in the fireplace, the collapsed sofa – everything in this rotten old house was gradually being broken down and consumed by those great, dark fronds. I try to stay positive in the soupy green atmosphere, but it’s like whistling in a swamp. All I really want to do is run out into the light.
‘How are you Daphne?’ I say, putting my bag down where I can.
She turns a waxy face in my direction.
‘I feel so ill,’ she says.
Daphne’s brother David follows me into the room. A tall, cadaverous man with crackling teeth and a demeanour as grey as his shirt, he has a disconcerting habit of smiling broadly after every sentence and rubbing his hands, as if he’d dreamed the whole thing and was excited to know what was coming next.
‘I made a space for the commode,’ he says. ‘At least she doesn’t have to go outside n’more.’
‘Well – that’s good.’

I’d been briefed about the whole, grim scenario, of course. About the number of safeguarding alerts that had been raised, by ambulance crews, community health workers and so on. But as Daphne and David had mental capacity to make decisions for themselves, they were perfectly at liberty to live however they wanted to live. If at any point in the future the house began to collapse – the roots of the palm finally undermining the foundations; the last coherent thread of supporting timber finally digested – well, then, the houses either side would be compromised and something would have to be done. For now, though, all we can do is visit, make recommendations, prescribe, admit, follow-up – a dance of health protocols round the base of that malign old plant.
Daphne gives me her hand. I feel her pulse.
When I look over at David he smiles.
‘Can I get you anything?’ he says. ‘A tea, perhaps?’
‘That’s kind, David, but I’m okay, thanks.’
‘Very well.’
From somewhere deep in the house, a soft crash, like a quantity of soil collapsing.
‘What was that?’
David shrugs, keeps smiling.

*

My visit over I say goodbye and pick my way back through the horror to the front door.
Up on the ledge on a level with the latch, a tiny teddy bear scrutinises me, one eye out.
‘Thanks for dropping by,’ says David, a coil of fly-spotted paper hanging over his head like a thought.
‘You’re welcome.’

*

The step outside the house is as brilliant as any ledge ever found that overlooked the world, and I’m momentarily stunned by the freshness and vivacity of it all.

A van pulls up a couple of doors down, a bright decal of suds and brushes on the side. Two men in caps and overalls jump out, and start unpacking a long, yellow hose, ready to jet-wash the path, the windows – each other, for all I know. They look purposeful, unstoppable, the kind of outfit Hercules could have subbed-out the stables job to with confidence.
‘All right?’ I say, stepping over the hose.
The nearest one adjusts his cap.
I wonder what other equipment they carry. Machete? Flame-thrower?  I’m tempted to ask for a brochure.
‘Mind how you go,’ he says.
‘Yep,’ I say, re-shouldering my bag, and carry on back to the car.

Elisabeth is cross.
I think.
There’s just the hint of ill-temper, the smallest upward curl at the corner of the lip on the face of the sabre-toothed tiger frozen in the glacier.
‘Not another one!’ she says. ‘I was about to have lunch.’
‘Sorry! I won’t keep you long. I’m Jim. from the Rapid Response Team. At the hospital. I’ve been asked to make sure you’re okay after your discharge from hospital. But I can come back later…’
‘No, no,’ she sighs, descending in one full and measured tone from disapproval to resignation. ‘I suppose you’d better come in…’
‘Shall I take my shoes off?’
‘Of course!’
I slip off my shoes, carefully shut the door, and follow her in.

The flat is as meticulously neat as Elisabeth, all the furniture, the side-table and display cabinet, the oak dining table and chairs, the riser-recliner and footstool, everything perfectly laid out in relation to each other, like pieces on a chess set that’s for display purposes only. Beyond the window there’s a panoramic view of the sea, featureless, silvery-grey, running out flat to the horizon.
Elisabeth composes herself in her armchair and watches as I put my bag down, sit on one of the dining chairs and begin flicking through her yellow folder.
‘So tell me what happened?’ I say.
‘What do you mean, what happened?’
‘Well – I didn’t get the whole story on the phone. Why is it you’ve been referred to us? Something about your hip?’
‘My hip?’
‘Didn’t you have an operation?’
‘Yes, but that’s not why I fell.’
‘You fell?’
She studies me.
‘Who sent you?’ she says after a while.
‘Your GP.’
‘She should know better.’
‘So tell me about this fall.’
‘The whole thing?’
‘Tell me why you went to hospital.’
‘Five years ago I bent down to pick up a pencil…’
‘Just the highlights,’ I say.
‘The what?’
‘The highlights. You know. The recent stuff.’
She narrows her eyes.
‘I’m getting to that, if you would only let me to finish.’
‘My apologies. Carry on.’
It’s lucky I chose a padded chair, because Elisabeth embarks on the longest, most convoluted story imaginable, a story that begins with a bunion on her big toe, culminates in a hip replacement, and develops in a picaresque way to cover just about everything, every trial and indignity, from the perils of dairy products, the cruelties of the hearing clinic, the struggles with technology, and the difficulties of finding reliable help these days. Everyone has a walk-on part: the podiatrist, the optometrist, the vascular surgeon, the physiotherapist, the cleaner – even Winston, a show-level border terrier owned by one of her friends, Mrs Catchpole, who is enthusiastic but unruly (The dog. Not Mrs Catchpole. I think.)
‘So now,’ she says, concluding abruptly. ‘What is it that you propose to do for me?’
And for the moment, I really don’t know.

It’s a rare moment, finding ourselves suddenly quiet like this, in the eye of the day’s hurricane, sitting with (almost) nothing to do, no new referrals to triage, old referrals to discharge; no carers or clinicians on the phone; no ragged lines of people waiting to handover; no doctors on-hold waiting to conference call another complicated care scenario; no wards pressing for capacity updates; no families wanting information, direction, confirmation, reassurance, answers… in short, the usual engulfing swirl that constitutes normal in the office of the rapid response team.
‘How was your day off?’
Michaela takes her face out of her hands and gives me a weary smile.
‘It was – weird,’ she says.
‘In what way?’
‘Well, Graham had some annual leave, so we thought what the hell, we’ll make a day of it. He’d never been horse racing, so I said why don’t we have lunch at the track? When we got there I saw this horse called Lazy Days, which was obviously a sign, so I put twenty pounds on – and won!’
‘Wow!’
‘When we eventually made it out of there it was later than we thought. I had a pool tournament that evening, way over the other side of town, and we were just thinking how to get there, and why don’t we blow our winnings on a taxi instead of the bus, when we were kidnapped by a gang of kids in a limo.’
‘What d’you mean, kidnapped? What kids?’
‘Not kids exactly. A mixture of ages. Turns out it was a stag do. This limo pulled over, the window went down, and this kid stuck his head out and asked me if we were married. Yes, I said, who wants to know? How long, he said. Twenty years, I said. Right, he said, in! And they all poured out of the limo and bundled us inside. It was very friendly, though. When we were in the back they gave us some drinks, and we all drove over to that casino the other side of town – which suited me, because it wasn’t too far from where the tournament was. Anyway, there we were in the casino, having a laugh, a few drinks, something to eat. And then I thought – why don’t I play the slots and calm myself down a bit? So I went over and sat down, and I hadn’t been there five minutes when the manager came over. Are you a member? he said. Yes, I said, and I showed him my card. It was a bit of luck I had it on me because I only joined when I went there about five years ago, and I haven’t been back since. Anyway, he looked at the card and then he handed it back and said Good! Because we’re running a promotion this evening and you qualify for a thousand bonus points! Which was about a hundred quid! So we played a bit more, toasted the groom about a million times and then headed off to the pool tournament.’
‘Don’t tell me – you won the trophy.’
‘Me? No! I was so pissed, I scratched on the break and followed the cue ball into the pocket.’