Ted is ninety-five, entirely independent, coping well. Unfortunately for Ted, a bout of high blood pressure, dizziness and intermittent weakness has made life more difficult for him recently. He hasn’t changed his clothes or had a shower in a good many weeks. The doctor has referred him to us for equipment and clinical observations, but so far, despite encouragement, Ted has refused any help with personal care. Today I find out it’s because he’s embarrassed. Most of the carers are female. He’s uncomfortable with that.
‘Come on, Ted. Why don’t I help you with a shower this morning?’
I lay out a change of clothes, and then he takes my arm as we walk along the hallway to the bathroom.
The walls are lined with photographs of family groups, from starch-collared, stiff-backed Edwardians to sprawling, gap-toothed Seventies kids, but generally the apartment feels cowed, cobwebby and quiet, with Ted, like some grumpy, nonagenarian badger, shuffling down his ancient burrow in the half-light.

It turns out, helping Ted take a shower is no easy thing.

At least there’s plenty of room. It’s an old apartment, and the bathroom is positively cavernous, the ceiling so high up no doubt the spiders in the corners have little family portraits of their own amongst the webbing. The bath itself is a grand, claw-footed affair. It would have been impressive fifty years ago; now, two encrusted drip-stains mark the tap end, the enamel is as pock-marked and pitted as an old saucepan, and the grouting is no more than a series of sprouting black lines between the tiles. At some point, Ted has rigged up a wooden frame around the bath, something like a four-poster bed, except the poles are only a quarter inch thick, and they wobble alarmingly when Ted grabs hold of them. We’ve provided a bath board already – a slatted plastic seat that fits across the bath, so he can sit on it when he showers and not get stuck. What complicates things is that the shower is actually a rubber hose with a sprinkler at one end and two rubber cups for each tap at the other. It’s almost impossible to set the temperature, which runs hot or cold suddenly and without any warning, despite elaborate attempts to get it right. Ted insists on using the shower head himself (He’s very clear about that. He only wants me there to help him in and out, to soap his back, and to hold the shower head whilst he takes care of his ‘bits and pieces’). The problem is, every time the water changes temperature, he yelps and holds the sprinkler away from himself, spraying water everywhere. Despite my plastic apron, I’m immediately soaked through, and the floor is flooded.
‘You could really, really do with a proper walk-in shower,’ I tell him, after the water’s finally – mercifully – shut off, and I’ve helped him swing his legs back out of the bath, and he’s sitting side-saddle, towelling himself dry.
‘They would never agree to that,’ he says. ‘I’m only a tenant. They’ll wait till I’ve popped off and then sell up. It’d be a waste, otherwise.’
‘Seems a shame.’
‘Maybe so. But there you are. Can’t be helped. Can you fetch me over that tin?’
There’s an old biscuit tin on a rotten little stand by the sink. I pass it over. He puts it carefully beside him on the corner of the bath and prises off the lid. The tin is filled with talcum powder, and a fluffy white powder puff. He paddles the powder puff in the talc, and begins energetically dabbing it all over himself, under his arms, his neck, over his chest, in his groin, down his legs…. In a matter of seconds he has completely disappeared in a chokingly sweet cloud of powder.
‘There!’ he says, as the talcum blizzard settles and I stop coughing. ‘I feel like a new man.’

The circus is due to start at four, and here we were, at ten to, standing at the foot of a roadside Jesus with bees flying out of his loins.
‘It’s a miracle.’
‘It looks like they’ve made a nest.’
‘Is that what they do, make nests? I thought they made honey.’
‘Yeah but first they swarm, and then they build a hive, and then they make honey.’
‘They’re going to struggle up there.’
She’s right. Jesus’ back is arched and his legs crooked-up, but still there’s not a lot of room between him and the column. We stand there looking up at the roadside shrine, the bees zipping in and out.
‘I think they’ll wait till they’ve got enough – you know – personnel, and then move on.’
The bees make Jesus’ suffering seem even worse, but if he feels it, he doesn’t let on, looking out across the golden French countryside with the same, mournful expression.
‘I think it’s up here,’ says Simon, tapping the map.
‘It says the conservatoire. Does that lead to the conservatoire? ‘
‘I think it leads to the cemetery.’
‘You wouldn’t have a circus in a cemetery. Would you?’
‘Depends on the circus.’
He folds the map and we head up the steep road anyway, the houses on either side shuttered up, no-one about.
‘Maybe that’s where they’ve gone. To the circus.’
‘If they are, it’s a long way off.’
It’s true. You’d think a circus would make a lot of noise. As it is, there’s an unbroken silence all around.
When we reach the crest of the road it divides into two, smaller tracks. One leads down to a little walled cemetery that overlooks the valley on that side; the other bends sharply right and round, into a hedged field that must belong to the school across the way. It’s only when we take this track that we start to hear something – a muffled PA, a dog barking, a small generator.
‘Up here!’
Snatches of red and yellow through the hedge, cars parked up on the verge, and as the track takes us further round, a stand of circus vans and trucks, each with the same peeling decal on the side: Le Petit Cirque, and busting through the lettering, a smiling clown. The tent is just exactly the kind you would come up with if someone asked you to sketch one: round at the sides, pointed at the top, with red and yellow stripes and guy ropes radiating from the centre. I guess it can only hold about thirty people, max, not allowing for the performers. The plastic of it looks worn and battered, like it’s travelled a great distance, all weathers.
‘Here we are! Come on!’ says Simon, striding ahead.
There are two performers standing outside the tent waiting to go on, a young woman in black spandex , and a short but muscular guy in an open necked shirt and flared trousers. Both of them are wearing make-up so thick it looks as if they applied it to each other with their eyes closed, for a bet. Simon goes straight up to them, and for a second I have a horror that we’ll end up going on with them and having to improvise a show. But I can relax: Simon gets all six of us in for a handful of euros; the tent flap opens and we duck inside.
It’s surprisingly humid, despite the coolness of the weather. There’s a rich smell of trampled grass, audience, animal, the sweetly spotted haze of unpacked canvas. A tiny, D-shaped arena picked out with red sleepers, with a stepped-auditorium of plain boards on three sides. There are four or five families waiting for the show. As soon as we’ve taken our seats,  a middle-aged woman steps out onto the stage holding a microphone. She immediately launches into her introduction, whipping the tail of the mic behind her, distributing her professional, four o’clock enthusiasm about the place. I don’t speak French, so I try to follow what she’s saying through body language and inflection. It’s difficult, though, and I’m pretty lost. She seems tired to me. After a scattering of fantastiques and incroyables and Le celebre jongleur mondialement – Daa-viid! I fully expect her to unplug the mic and go back behind the screen for a lie-down.
Daa-viid! turns out to be the guy in the open-necked shirt who sold us the tickets and let us in. It’s immediately apparent he has lost all the fingers on his right hand, and I can’t help wondering if that was from juggling knives. He’s good though – amazing, actually, considering how difficult it must be to catch things when you’ve pretty much only a palm on one hand. He moves efficiently from balls to clubs to rings, whilst the sound system blasts out The Windmills of your mind on a loop. We applaud loudly to make up for the lack of numbers. He bows deeply, gives a little skip, and then runs out back through the flap the woman holds open.
She gives aother speech, exactly the same as the opener, except this one mentions hula hoops. The young woman who’d been standing outside the tent with David comes on, with about fifteen hoops on either shoulder. Over the next ten minutes she spins the hoops on her hips, arms, legs, finishing with all the hoops at once, gyrating dangerously like a great, clacking, whirlwind of plastic. She lets the hoops fall to the ground, steps out of them, takes the applause and the hoops and jogs back through the flap – then almost immediately comes out again with an elderly man dressed in white shirt and corduroy trousers. Together they assemble a little platform in the middle of the ring, and stack a half dozen chairs to the side. Whilst they’re doing this, the woman – who I’m guessing is the old man’s daughter and the hula-hoop girl’s mum – gives us another monologue about something world-beating, world-class, giving the mic lead a flip every now and again, to re-energise her smile and move things along. When finally the stage is set she throws her right arm out to the side, shouts Daaa-viiid!, takes a step back, and David runs in again, dressed this time in a lycra one-piece made up to look like a suit. His demeanour is changed, too. He’s more urbane, the kind of insouciant smile and knowing wink that seems to promise that yes, he’s about to do something amazing and no, we shouldn’t try this at home. He puts one of the chairs on the platform, puts his damaged hand on the back of it, his good hand on the seat, and flips himself up into a handstand, holding it there for the applause. Once he’s back down, he puts another chair on top of the first, and repeats the trick. And so it goes on, the stack of chairs growing in height, the arrangement increasingly precarious, the woman – who I’m guessing is his wife – coming on half-way through to help him get on and off. Daaa-viiid! she cries at the end. We clap. The old man comes on to help pack away. Another announcement, and then the old guy comes on with a goat.

I feel sorry for all of them, but especially the goat.

It’s a cute, pygmy variety, black and white, with fierce silver eyes and neat horns that curve left and right. It’s on a lead. The old guy is shouting stuff out, flicking a whip, making the goat climb up on a star-patterned platform, kneeling, or rising up on its back legs. We all clap, but I feel uncomfortable. It’s one thing, struggling to make a living as a jongleur, a hula-hoopeur – but at least they have a choice. The only way I can find any comfort is to think that the goat – and then the llama, and birds, and even performing cats that make their way onto the little D-shaped stage for our entertainment – is that at least they have a better quality of life than many of the animals we farm for food back in the UK.
But I’m relieved when the animals are done and we’re back to the woman and her announcement – the
world-famous clown, apparently – Daaa-viiid!
He waddles on dressed in an orange and red check suit, a red nose screwed into the middle of his face, some dabs of white and black on his face. There’s some schtick between him and the woman, which I can’t begin to understand, until Simon leans in and says that ‘there’s been a clown strike / he’s refusing to go on.’ In his place he gets three children out of the audience, but that’s as far as the strike routine goes. He makes some balloon glasses for one kid, a balloon crown for another, and a balloon giraffe for the kid that cries and runs back to into the auditorium.
The woman then has a turn at performing. She gives a short magic show, at one point parading an empty cylinder round the stage, presenting it for our inspection with a worryingly intense smile, like she’s fully prepared to hit us with it if we reach out to look more closely. She pulls flowers and flags out of the cylinder, and then turns to the bird in the cage her daughter has just brought on. After some finger-to-mouth expressions of wonder and alarm, she suddenly claps the cage flat, opens it again, and drags out a rabbit – an extraordinary animal, its fur so clumped-up at first I think it’s just a hat.
Applause, retreat.
David makes one final appearance, to do some balancing on variations of plank and cylinder.
The children buy pennants the hula-hoop girl brings out. Then the show is over and we all file outside, saying thank you to David, his wife, daughter and father, lined up to wish us bon voyage. After watching the animals grazing in the field outside, we head back down the lane,  towards home.

I don’t know what’s more depressing – thinking about the goat, dropping down to its knees at the flick of the old man’s whip, or the family striking the tent each evening, packing it all away, counting up the few euros they made that day, wondering how much longer they can go on.

When we reach the statue of Jesus at the crossroads, I notice that the bees have all gone. Jesus’ head seems a little lower than I remembered. Maybe he’s relieved the bees have found somewhere else, although it might just be an optical illusion, the effect of the sun, much further down now, almost completely obscured by the hills on the far side of the valley.

 ‘Did you see that programme about the woman who rescues baby elephants? It’s such a shame what’s happening to them. I think the parent elephants are getting killed by the poachers for their tusks, and the babies are left to fend for themselves. There’s still quite a demand for the ivory, of course, and all those ridiculous herbal medicines, and what have you. And I don’t think it helps that when the elephants go from one place to another they always go straight, like they’ve always done, never mind there’s a village in the way. It’s not their fault. An elephant’s a big old item, though. It’ll do a lot of damage.

‘You see, mankind’s in conflict with the animal kingdom. We won’t have these lovely animals for much longer. We’re using them all up. It’s the same with the monkeys, the orang-utans. We’re cutting down all their forests and they haven’t got nowhere to go. We need to start doing something about it, though, or  what’ll the planet be like in future?  They’ve named this age after us, the Anthropocene – and I tell you what, that’s hard to say without your teeth in – because you see we’re a thing now, the human race, like asteroids, or the ice age. We’re killing things off on a huge scale. It was the same with the whales and the Victorians. When you think of those magnificent animals, cut to pieces, and for what? A bit of oil for your lamp? A few corsets? I don’t know if you remember, but we used to have anti-macassars on the backs of chairs, because all the men had this oil on their hair and it stained the fabric. And when you think of them poor old whales…

‘But it’s hard to tell younger countries not to go the way we did, with the industry and the pollution and what have you. It’s like saying: we’ve enjoyed all this progress, we’ve made a stack load of money, but sorry, mate – you can’t do the same because it’s not good for the planet. How do you justify that? You’ve got to make it worth their while, or you’re on a hiding to nothing.

‘I never had an education. I went to the local school and then I worked in a bank. I had this aunt with a bit of clout. She saw something in me and got me an interview. They sent me up to London, to Lombard Street, the heart of the city, to sit this test. It was a huge thing for me then. There I was, a tiny little mouse from the country, getting off the train with my little packed lunch, stepping off into another world! A skyscraper world! They sat us in the biggest, most grandest hall you could imagine. I was so nervous I could hardly write. But I worked my way through it. There was this woman walking round looking over our shoulders, and she came over to me and she said “I’d have another look at question five, if I were you”, so I did, and I passed with flying colours! That was nice of her, weren’t it? So the next thing I knew I found myself working in a bank. Not on the desk, mind. They didn’t let women out front on the desk in those days. I was in the back, working the machine that processed all the cheques. That’s where I met my husband. And when we got married we bought a little sweet shop.

‘You should’ve seen it. Lovely teak counter, rows of jars behind me up on the wall. It was quite a knack,  climbing that ladder to fetch a jar without breaking me neck. They were heavy items, you see. But we used to sell all kinds of things. Necessaries, you know. Bread and milk. Newspapers. I used to be up at half past five in all my make-up, marking out the papers for delivery. I wish I’d took a photograph. It’s all gone now, of course.

‘We had this rocking chair just beside the counter. People used to come in, take a seat, light a cigarette (you could in those days), and just chat. Oh – I got to know everybody. All their problems. I loved it. I didn’t want to retire, but I suppose everyone’s time runs out sometime. So here I am, chatting to you, trying not to fall out of bed. Who’d have thought?

‘But that’s enough about me. Tell me about you. Do you have a family?…’

I knew it would be difficult to find. The Beeches, Crossways. The very minimum of information (demonstrating the upper class theorem which states that the amount of words in any particular address is inversely proportional to the amount of money it takes to acquire it). I’m surprised there’s not a family crest on the fax. There’s a postcode, though – a sop to modernity – and my satnav has certainly done its best, but still I need help with the last little stretch, because the flag’s in the middle of an expensive nowhere, and I’m worried that a guy like me in a car like this driving slowly from grand stone gatehouse to grand stone gatehouse will inspire an armed response.

The voice when it answers is as brisk as a knighthood.
Yes? Hello?
‘Oh, hello! My name’s Jim. I’m with the Rapid Response Service. I’ve been asked to visit Mr Bletchley and I was wondering where you were.’
I’m sorry – who did you say you were?
‘Jim. From the Rapid Response. You know. The hospital.’
Who sent you?
‘I think it was Mr Bletchley’s GP.’
I can assure you it wasn’t. I’m a GP.
‘You’re the GP?’
No. I’m A GP. My husband’s GP is Dr Smith. Shouldn’t you know that? And I can assure you I’ll be talking to Dr Smith as a matter of urgency, because this is simply unacceptable. What did you think you were coming here to do?
‘Anyone who gets referred to us has an assessment by two people – a clinician to do the blood pressure and so on, and then a physio or OT to assess mobility issues, the social side of things…’
And you’re a clinician are you?
‘I’m what they call an Assistant Practitioner.’
And what is that? A nurse?
‘No – more like a nursing assistant.’
What nonsense! My husband’s vital signs have been taken already today. Someone called Bartlett.
‘Bartlett?’
Yes. Bartlett. He said he was from the Rapid service people or whoever you are. Now look. This is ridiculous…
‘I don’t know anyone called Bartlett.’
I can’t help that. What I can help is my husband being bothered by an endless stream of people traipsing through the house on some fool’s errand. This is absolutely not what I intended. I asked the care agency to refer my husband to an occupational therapist because he’s been struggling with his mobility. And now all of a sudden I have nursing assistants dropping in willy nilly at all times of the day and night to absolutely no purpose.
‘Would it be better if we had this conversation face to face, rather me sitting by the side of the road on the phone?’
Yes. I think it probably would. Just park in the street and I’ll let you in.
‘Could you tell me where you are then?’
What do you mean? Just do what you did before.
‘But I haven’t been before. That’s why I called. To find out where the house is.’
This is absurd. I shall be talking to Dr Smith, you know.

She gives me directions to The Beeches – strict instructions to park out on the road, as ‘the gardeners are in with all their vans and things and there won’t be room’. She’s right about that . A team of gardeners in neon orange safety gear and hard white hats are standing around having coffee, screened from the house by a stand of rhododendron, a giant orange chipper nearby. They nod good morning to me; one of them, the tallest and toughest, tosses the dregs of his coffee off to the side, in a grimly knowing kind of way, like he fully expects to be feeding me head first through the chipper in a couple of minutes.
I walk on up the gravelled drive, rap the lion’s head knocker on the iron-banded door, and step back.
After a long, corridor’s march, Mrs Bletchley appears, an elderly but vividly animated woman, ruthlessly dressed like some kind of debutante samurai, in slacks, polo neck, pearls and earrings, with a phone pressed to her ear.
No. I don’t know who it is. Another Bartlett she snaps into the phone, and after running me through with her eyes, nods for me to go through to the lounge, where Florence, the live-in carer is wringing her hands and waiting.
Luckily for me, Florence is the perfect antidote to her employer, a natural correction, in the same way you often find dock leaves growing next to stinging nettles.
‘Have a seat’ she says, kindly indicating an impressively plump sofa with the flat of a perfectly manicured hand. A great, limestone fireplace dominates the room, a discretely-lit oil painting above it – dawn on a Scottish loch – and then on a low display case to the side, a collection of ceramic bulldogs.
‘Can I get you a tea or anything?’
‘No. It’s okay, thanks.’
She fetches me the folder, tells me everything I need to know. I can see immediately there’s been a duplication. Ricky, one of the other assistant practitioners, has already been in that morning for the clinical assessment. His surname’s Partetto, and I have to admit, when he says it quickly, in his Italian accent, through that trendily thick beard, it’s quite conceivable you might hear it as Bartlett. All that Mr Bletchley needs now is the OT assessment, which should be anytime soon. I tell Florence what’s happened; she smiles with great warmth and understanding.
‘That clears that up!’ she says, and then glances towards the door. ‘Mrs Bletchley will be pleased.’

Denis takes a while to get to the door. It’s a long way from the bedroom, he’s exhausted, his legs are shot.
‘They took all the veins out for the bypass,’ he says, turning round painfully.
‘I don’t know they’d take all of them.’
‘A lot, anyway,’ he says. ‘It’s a big operation. The biggest.’
I follow him back through the flat, everything cream and white, a designer’s rule between each chrome fitting, glass table and black leather chair, framed pictures of nothing in particular, cracked willow with fairy lights in a floor-standing, rough stone vase – all the warmth and amiability of a show home.
Denis makes it back to the bedroom and climbs into bed.
Above it, a sepia print of the Golden Gate bridge.
‘I’ve put a chair out,’ he says, gathering the quilt around him.
His yellow folder is on the seat. It’s stuffed full of everything from final demands to hospital discharge summaries; I have a job to keep it all together on my lap.
‘No-one wants to know,’ he says, watching me from the bed. ‘I’ve got heart problems, back problems, they bodged my knee and lied about it. I’ve got all this going on and I’ve paid in all my life and I don’t get any of the attention I deserve.’
And then he turns his head to the side and cries – or, at least, gives a strange, dry-eyed approximation, like he’s been hiding one of those tragedy masks amongst the folds of the quilt, held it up to his face, and then just as suddenly dropped it down again.
‘I’m sorry you’re feeling so low,’ I say. ‘Have you spoken to your doctor?’
He straightens up and looks at me with his normal face.
‘They just fob me off with more pills. They don’t care.’
‘What about talking therapies? You know – counselling and the rest. Would that help, d’you think?’
‘Talk about what? How my life’s fucked up? How I’ve been dicked around and hung out to dry? How’s talking going to help anyone?’
‘I don’t know. I think it’s good to get these things out in the open sometimes. Otherwise they just grow out of proportion and take over.’
He turns to the side again, another brief display of the mask.
‘I’m sorry,’ I tell him, putting the folder on the carpet, and getting out my obs kit. ‘I can see you’ve got a lot on your plate.’
He straightens again.
‘My daughter won’t talk to me,’ he says, pulling a tissue from the box by his side and dabbing his nose.
‘Why? What happened?’
‘Laura, the granddaughter, she was due to get married, and of course it causes all kinds of ructions, ‘cos no-one likes the guy. I mean I didn’t like him either, but – what do I know? Anyway, my daughter was putting her under a lot of pressure, so Laura comes to me and asks me to get involved. Which I try to do as nice as I can – but then it all blows up and I get the blame and now nobody’s talking to me. Me! So sick they had to open my chest and stuff a load of leg veins in there to keep it all working. The most dangerous operation you can have. But they don’t want to know. They don’t ring, they don’t write. I asked the doctor to call my daughter and tell her how sick I am, but the doctor says it’s something I’ve gotta sort out for myself. Me! In my condition!’
‘It’s difficult. But I’d be tempted to take a deep breath and make the call. I bet she cares more than you think. Someone has to make the first move.’
‘Nah, fuck it,’ he says, tossing the tissue in the bin. ‘It’s not gonna be me.’

After I’ve finished the assessment and written up the notes, he seems to brighten up a little.
‘Pass me that iPad, could you?’ he says. ‘D’you know much about these things?’
‘A little,’ I tell him. ‘Shame my daughters aren’t here. They’re pretty good with this stuff.’
I wonder if it was tactless to have mentioned daughters, but he’s too engrossed with the iPad to notice.
‘What’s the problem? Email?’
‘What? No – the iPlayer’s stopped working. What d’you think it is?’
He hands me the tablet.
‘It looks like it needs an update.’
‘Can you do it?’
‘I’ll have a go.’
I click around. Luckily, it seems to work.
‘There!’ I tell him, handing it back. ‘Ready to go.’
‘Great,’ he says. ‘I can watch the last episode of Poldark.’

There are a dozen, rough concrete steps dropping precipitously from road level to Jack and Janice’s front door. The patio at the bottom there is so sheltered –  the cottage behind, the terraces of the garden in front – that all the containers and hanging baskets there are still going strong despite the lateness of the season.  Great, fleshy ropes of tradescantia hang in tangles overhead, ornamental roses line the wall beneath the window, lavenders and daisies ranged in a variety of pots along the path, and to my right, a tall fuchsia, its delicate lanterns vividly pink and red in the grey morning light. There’s a solitary honey bee moving between the flowers. I watch it whilst I wait for someone to come to the door. I bet it can hardly believe its luck. Such riches, so late on. But how much longer can the flowers last? And how long the bee?
Jack opens the door.
‘Yes?’
I start to tell him who I am, but he’s so deaf I have to start again with my mouth up to his ear.
‘I suppose you’d better come in,’ he says. ‘There’s someone else here already. I don’t know if you know ‘em.’
The hallway’s so narrow, and Jack’s so frail, we have to improvise a slow tango for me to come in sufficiently for Jack to close the door.
‘You don’t see anyone for months on end and suddenly it never stops,’ he says.
‘Feast or famine,’ I tell him.
‘Sorry?’
Feast or famine.
‘I’ve had some toast,’ he says. ‘But never you mind about me. She’s upstairs in bed, if you’re interested.’
‘Shall I go up and say hello?’
‘Eh?’
I point.
He nods.
‘I try to encourage her but it don’t do no good,’ he says, then ‘Oh! Right! I was s’posed to be making tea!’ Then he turns painfully and struggles off into the kitchen, wobbling from side to side like a bear with sore paws, swiping the radio as he passes, which comes on at such volume I can hear it clearly all the way up the stairs.

Ellen, a nurse from another team, is in with Janice. Sometimes these overlaps between services are frustrating – it’s a muddle, things get missed – but today it’s a straight-up piece of luck. Ellen’s so experienced, and so warm, it lifts and illuminates the whole assessment.
‘I just love that bathroom,’ she says, dropping the dirty flannels into the basin of water and handing it to me. Janice smiles vacantly from her freshly-plumped pillows.
Ellen’s right. There’s a cute roll-top bath, with an equally ancient pedestal sink next to it, chrome and glass shelving, a brass shaving mirror, a porcelain soap dish shaped like a fish, and on a ladder of rails, a stack of brightly coloured, neatly folded towels.
‘He runs a pretty nice place,’ I say, coming back into the bedroom and peeling off my gloves.
‘Ye-es’ says Ellen, flicking through the folder. I know what’s she’s thinking. Even though Jack’s still managing to keep things together, Janice is deteriorating quickly. It’s going to be difficult to cope in such a tiny cottage.
‘Here we are!’ says Jack. Somehow he’s managed to struggle up the stairs with a tray of tea. Two china cups for me and Ellen, a beaker for Janice.
‘Don’t she look a picture! Eh?’ he says, holding on to the handle of the door whilst he gets his breath.
And anyone would have to agree. She does, she really does.

‘Three in one day!’
‘Wow!’
‘Yeah. I think the Grim Reaper must’ve swapped his scythe for a strimmer…’

It’s certainly unusual. We’ve had several End of Life patients on the books for some time now, picking up the slack from the regular palliative agencies struggling to cope after years of cuts and under-funding. These End of Life patients are invariably double-ups – needing at least two people to deal with the complex manual handling issues relating to bed care. It’s a significant strain on the service, leaving us with little capacity for anything else. Of course, we’re all shocked to hear about the deaths; we’ve built up close relationships with the patients and their families over the weeks. But aside from the emotional impact of the loss, three patients in one day? Well, at the risk of sounding callous, it’s a dizzying release of manpower.

The carers sit round the big table at the beginning of the shift, going over the details as they write down their patients for the day.
‘So which three was it, then?’
‘Well first off was Old Mr Denton.’
‘Oh no! Lovely DD.’
‘Yeah. It’s a shame. They were just setting up the driver when he went.’
‘Still. I think most of the family made it over. He’d have been happy with that. Who else?’
‘Jenny C.’
‘That’s a shock.’
‘Tell me about it. I was there yesterday and she was showing me pictures of the new baby.’
‘That’s terrible. Poor Jenny. I hope it was quick. Who else?’
‘Errol.’
‘Oh my God! Finally!’
‘Yep. It was incredible how he hung on.’
‘I didn’t think he’d survive the pad change last night he was so bad. But he’s a fighter, I’ll give him that.’
‘Here – chuck us that eraser.’
‘Who found him?’
‘Darryl did. He was there with Jane and he said as soon as he walked in the room he knew. They checked him over, then went in to tell Jeanette.’
‘How did she take it?’
‘Pretty well. She said “Oh yes. I kind of knew he’d gone when I took his tea in and he didn’t make his usual comment.”’
‘She’s a funny one. But I think it’s going to hit her hard, when all the dust’s settled.’
‘Whose biscuits are these?’
‘Have one. They’ve been kicking around for ages.’
‘You’re not selling them to me.’
‘I think Sandra found them down the back of the fridge.’
‘Three in one day!’
‘I know! That’s knocked some gaps in the rota.’
‘Won’t last.’
‘No. You’re right.’ Dunks one of the biscuits in her tea and finishes it in one swallow. ‘Never does.’

I’m met at the door by a young guy with a buttoned-down manner and a way of speaking that’s low and whispered and slightly off to the side.
‘There’s someone here from the hospital come to see you,’ he says, over his shoulder to the locked door behind him. ‘Shall I take him down to the living room?’
Yes. I’ll be out in a minute.
He smiles at me (if he bowed I wouldn’t be surprised), beckons me in, then closes the door behind me with one hand on the latch and one flat on the panel to stifle the click.
‘This way.’
A long, narrow corridor, bare walls, widely spaced down-lighters, every door closed, until he stops in front of one, opens it, and stands aside to let me through.
‘Shan’t keep you,’ he says, and with a deferential scrape, leaves me alone.
The living room is well-named; there’s scarcely room to do anything else. A cluttered, boxy affair, it’s completely dominated by a waxy white leather sofa and a glass table covered with lifestyle, physical culture and health magazines. The sofa is enormous, like a gigantically plump mushroom grown fat on the dark shag-pile carpet, and silence.
I hold on to my bag, sit down and wait.
After a few minutes another, older man appears at the doorway. He’s wearing stripy pyjama bottoms, with a Scottie-dog patterned bathrobe draped over his shoulders, the only way he can wear it with the sling he has on his left arm. I stand up and introduce myself. He holds out his left hand; I reach across to squeeze it.
‘Nice to meet you.’
‘Do sit down.’
He waits for me to resume my place, then carefully guarding his injured arm, takes a seat next to me. He’s an extraordinary figure, with greasy golden hair that runs down from a prominent forehead to curl inwards at the jaw line – a formal crop that with his beaky nose, lidless eyes and haughty blue expression makes him look like he’s just stepped down to earth from a twelfth century stained glass window. He gives his head a shake, as if he’s clearing a little mental space to deal with whatever comes next, then slowly turns his eyes on me and smiles.
‘I expect you know the story,’ he says.
‘I didn’t get all of it.’
‘Well let me fill you in, then. You see, I’m very good, and I go to the gym quite regularly. I wouldn’t describe myself as a body-builder, quite, but I do have an interest in physical culture and so on. Unfortunately my usual trainer was delayed, and inadvisably, I attempted some bench presses without him there to spot for me. Awful, stupid, idiotic.’ He gives his head another little shake. ‘It could have been fatal, for goodness sake! Anyway, the first set was absolutely fine, the second was a little more of a strain. And Mike still hadn’t arrived. But you see one of my things is cussedness. I’m quite cussed. The more difficult something is, the more tempted I am to just go at it. So I put on some more weights and started the third set. Well of course it all went disastrously wrong and I suffered a collapse. Luckily I managed to direct the bar off to the side, but it wrenched my shoulder and tore up the superior and inferior glenohumeral ligaments. As I’m sure you know. Hence the sling.’
‘Ouch.’
‘Ouch indeed.’
He smiles at me again.
‘I must say, you’re a little more relaxed than your colleague.’
‘Jane? I’m surprised to hear you say that. But then – I suppose you have to realise – a single woman, coming into a flat with two men. When it’s dark outside. I think if I was her I’d be a little on edge.’
‘Oh please!’ he says. ‘On edge! Look at her. She should be so lucky.’
He adjusts the hem of his bathrobe, then very casually lifts his chin and says: ‘I wouldn’t give her to my son.’

I can’t ignore the foot.

I’ve blundered into this situation like the most naïve of fools – Hello sky! Hello trees! Hello sheltered accommodation warden! – and now here I am, mesmerised by that foot, struggling to think how to make things better, how to get away in one piece.
‘None of you care what happens to my mother. You just want her off your hands as quickly as possible.’
Thump, thump, thump goes the foot.
It’s like Thumper from Bambi. If Thumper had grown two metres, aged forty years, put on a cable-knit sweater, hadn’t shaved for a week.
‘I’m putting in a formal complaint. I’m making this a safeguarding issue. I think it’s an absolute disgrace. A family friend is a nurse and she agrees with me. This should never have happened.’
Thump, thump, thump.

I do what I always do in these situations, which is to adopt a more aerodynamic profile. I make sure I’m sitting in an attentive but neutral position (but not too obviously); I maintain eye contact (but not too much);  I listen to his concerns and then repeat them back to him in a way that shows I’ve listened and understood what he’s said (but not too glibly). I’m amazed he doesn’t laugh out loud, it’s all so obvious, a TedTalk on Dealing with Difficult Customers. But it seems to work. The foot taps a little less aggressively, and settles into a vestigial twitch.

This unexpectedly hostile reception isn’t my only difficulty. There’s also a strange disparity between the son’s anger and his mother’s situation. If you had told me to study the son’s fury in close-up and then guess the scene that inspired it, I would have said that his mother must have been fly-tipped by the side of the road at midnight. But here she is, sitting very comfortably, thank you, on a sofa with everything to hand, in a beautifully warm and well-kempt flat, carers arranged for the morning, food in the fridge, a personal alarm, and family that lives locally. And whilst it’s true she suffers from dementia, it hasn’t progressed to a disabling loss of cognitive function, more of a mild, essentially benign dissociation with the present.

Careful not to apportion blame or make promises I can’t keep, I tell him I’ll look into the circumstances of the discharge, and in the meantime, offer some things that we as a service can do to help right now. He breathes heavily through his nose as I lay out my wares: a toilet aid, a perching stool, a walking stick.
Thump goes the foot.
A review of the longer-term issues of care support.
Thump.
‘Why wasn’t this all taken care of before my mother was discharged? She struggled to get out of bed this morning and wet herself.’
‘I’m sorry to hear that.’
I’m also tempted to ask why he wasn’t able to be at home with his mum when she came home, to make sure everything was okay in the short term. I don’t, of course. Rule number whatever: don’t get drawn into an argument. And anyway, it’s essentially a monologue with some gaps for comment, certainly not a conversation. The practicalities are almost secondary. For now – and for whatever reason – he simply needs to vent his frustration, and if I can’t for the moment see what’s really behind it all, at least I can acknowledge it, however uncomfortable it makes me feel.
‘Okay. Well. Actually – the reason I’ve been sent round today is to do a simple medical screen,’ I tell them, slowly drawing out my folder of paperwork.
Thump.
‘I need the loo,’ says his mother.
‘Okay. That’s handy! Because one of the things I need is a sample of urine!’
His mother stands up. I offer my arm. She threads her hand through the crook of it and we walk slowly out of the room together, bluebirds twittering and singing in a circle over our heads, all the woodland creatures, the owl, the family of field mice, the deer and the baby horse, all lining up to smile and nod as we process – all except Thumper, the old crosspatch, who folds his arms and scowls at us from the other side of the room.

One of the other nurses hadn’t been able to take Mary’s blood that morning so I’ve been assigned to try again this afternoon.
The day is high and blue, the kind of easy, late October day that makes you forget you’re standing on the edge of winter, with the clocks back, the nights shuffling up, and a prospect of colder days to come.
Mary answers the door in a red silk wrap patterned with Chinese dragons and lilies. She’s frail and watchful behind a pair of heavy black-framed spectacles.
‘Come in out of the cold,’ she says, standing aside. ‘Lord – what would my son say if he knew I was answering the door like this.’
She shuts the door, and then takes a seat at the little table in the window.
‘I suppose you’ve come to have a shot, too,’ she says, laying her right arm amongst the papers and letters and unopened catalogues, bunching her sleeve up. ‘I don’t think there’s much there, but be my guest.’
I set out my kit and then inspect her arm, tapping up the likely candidates.
‘Here!’ she says, ‘you’re not supposed to just waltz in and beat me up!’
‘No. It doesn’t look good, does it?’
I put the tourniquet round her upper arm and prepare to go for a vein.
‘So what did you do before you retired?’ I ask, as much to distract her attention as anything else.
‘I was a nurse,’ she says. ‘Well, come on – you did ask.’
‘Uh-oh! A nurse? Now I’m for it.’
‘Don’t be daft. It was a long time ago and I’ve forgotten more than I knew.’ But she leans in as I insert the needle.
‘Anything?’ she says.
‘Not a thing.’
‘I suppose you’ll just have to keep going until you strike oil,’ she says, relaxing back again. ‘Don’t mind me.’
We chat about her symptoms whilst I look for a different site.
‘I was in Marks and Spencer’s,’ she says. ‘Don’t laugh. And I was standing with the assistant, looking over all the bags, and I was thinking how they didn’t have much – certainly nothing I’d want to carry out in public – and then suddenly I couldn’t get my thoughts in order.’
‘You were confused?’
‘I was muddled! More than that – I just didn’t know what I was doing there or what I was supposed to say.’
‘I’m like that, in Marks and Spencer’s.’
‘But I couldn’t understand what any of it meant, Jim. And my heart was going a mile a minute. And the assistant was looking at me like I was some kind of alien or something. And I just had to get out.’
‘So you went outside?’
‘I did. I left the store. And I stood outside, in the fresh air. And everyone was walking past me, all busy with their own lives, all going somewhere, and I just had to sit down and let it wash over me.’
‘Did you feel short of breath? Sick, dizzy?’
‘No. Nothing like that. I just kind of felt not myself if you understand me. You hear people say it a lot, don’t you? I’m not feeling myself today. Well that’s exactly what it was. I felt like someone else, in my own body.’
She pushes her specs back up her nose and stares at me.
‘I expect you think I’m ready for the fella with the big white butterfly net.’
‘No. I mean – it might be an anxiety thing. But it could be something else.’
‘Like what? My heart, d’you suppose?’
I shrug.
‘You’re on quite a few meds. Some of them have changed recently. It might be some kind of interaction. I don’t know enough about it.’
‘Me neither,’ she says, sadly. ‘There! That’s flowing now! Thank Christ for that.’
I manage to fill the two phials I need. She presses the square of gauze to the crook of her elbow as I loosen the tourniquet and withdraw the needle.
‘There! All done! It’ll be interesting to see the results.’
‘Interesting’s not the word.’
Mary’s quiet as I pack my things away. Eventually she says: ‘My daughter-in-law’s on the case, you know – phoning up the doctor to find out what’s going on. Marlee’s a holy terror, bless her. She won’t let them get away with anything.’
‘Quite right. But don’t give her my number, whatever you do.’
‘Ah – you’re all right. I’ll put in a word.’
I write out the blood form.
‘So where did you do your training?’ I ask her. ‘Down here or over the water?’
‘London,’ she says. ‘I loved it, y’know? It was fantastic. Me and the girls, we used to go dancing in the Tottenham Court Road. And – you’ll laugh – but we used to give out these silly fake names on the door: Clare Voiyant. Sonya Bike. Theresa Green. They must’ve known, but they just used to shake their heads and wave us through. We had a grand ol’ time of it.’
‘I bet you did.’
‘I’d go back there in a snap.’
I remove the gauze square, inspect the wound, put a plaster on it. Mary watches.
‘Y’know, I used to work in the community,’ she says, pulling her sleeve back down. ‘I remember, one of my patients, he was this beautiful musician – such a beautiful man. He’d make you gasp just to look at him he was so beautiful. And he used to take heroin. I’d go round to see him, and he’d be there, warming the spoon over the candle. And he was so careful to get every last drop … it was terrible to see. I asked him once. I said to him – why do you put that shit in your veins, pardon my French. And he looked at me, with his beautiful blue eyes. And he said, They’re all doing it, Mary. All the musicians. They’re all on the needle.’