Jean slipped off the sofa and couldn’t get up again. Even though she’s ninety-four, she’s been pretty mobile and independent, but just lately she’s been feeling a little off-colour, weaker in the legs, slightly nauseated. She tried everything to get back up, different angles, improvising with furniture, any object she could think of to help. Nothing worked, so she sat there, marooned on the rug, stroking the cat, wondering what to do. The phone was within reach, thank God, so that was some comfort. It was midnight, though, too late to call her grandson, she thought. He’s got work in the morning. He needs his rest. It wouldn’t be fair. So she made herself as comfortable as she could and stayed there until mid-morning, when he happened to pop round during break.

The doctor was called. She couldn’t find anything wrong particularly, although it would have been useful to get a sample of urine, to screen for UTI. Jean was adamant she didn’t want to go to hospital, and to be honest, the doctor didn’t think it was entirely necessary. She would make a referral to The Rapid Response Team, who’d come in and blitz the place with equipment. They could set up a micro-environment downstairs, with grab rails, a commode, zimmer frame and what have you. Take blood. Maybe get that urine specimen. And start on a course of physiotherapy to get things working again.
Jean was anxious, but the doctor said there was every reason to be optimistic.
‘I don’t want to go into a home,’ said Jean.
‘We’re not there yet,’ said the doctor, closing her bag. ‘Nowhere near.’

Jean’s daughter Ruth caught the next train down. She’d be there to look after her and superintend all the comings and goings.
‘We can get a wet room installed downstairs,’ she said. ‘Plenty of room to move about, a shower, raised toilet. It’ll be fine, mummy.’
‘Don’t let them put me in a home, Ruth.’
‘No-one’s thinking of that. All we’ll do is change things round a bit. Get a bed put in downstairs, so you can look out into the garden and see all the birds.’
‘That’ll be nice.’

*

My visit happens to coincide with Jackie, the OT. Jackie has been working in the community for a good many years. It’s always a treat to see her car outside.

I was worried about her the other day, though. When I came into the office she was being comforted by one of the nurses. As a senior practitioner, Jackie’s expected to act as department co-ordinator now and again – a hellishly stressful role, especially at a time of increased workload, decreased budget, a perpetual fog of re-organisation blowing through the department.
‘The director was here first thing,’ she said, ‘striding through like the Master of the bloody Universe.’ She blew her nose on a hankie. ‘Everything all right? Good! Good! I can’t remember the last time I saw him down here. Can you? I mean, can you?’
The nurse rubs her shoulder.
‘What’s the use?’ she said. ‘If I have to go, fine. I’ve got nothing to lose. But this? This is crazy.’
It’s a worrying development. When practitioners as valuable as Jackie are threatening to quit, you wonder how tenable the system is.

Out of the office, though, Jackie quickly recovers. The community is where she belongs, where she thrives. Like the best community health practitioners, she has a highly developed sense of where people are, what they need, and how best to give it to them. Her skill is so natural that in using it she heals herself as much as the patient.

After she’s introduced herself to Jean and Ruth she settles onto a stool to get the whole story, clarifying points when she needs to, making sure she knows exactly what happened, and what might be needed. Jean is a little guarded at first. Ruth explains her mum’s anxiety about losing her independence.
‘She’s lived here sixty years,’ she says. ‘She doesn’t want to go anywhere else’
‘Of course not,’ says Jackie. ‘Why would you? A lovely house like this. But you know what? There’s so much we can do to make it so you don’t have to move. That’s why we’re here. To help you stay at home.’
It’s reassuring stuff, but even I can tell that Jean isn’t entirely convinced. All those hours on the floor have dented her confidence as much as anything.
Suddenly, Jean’s cat, Arthur jumps up on Jackie’s lap. She immediately makes a fuss of it.
‘You’re gorgeous!’ she says. ‘Aren’t you? What a sweetie?’
‘He certainly rules the roost,’ says Jean.
‘I bet you do!’ says Jackie, tickling it under the chin. ‘I’ve got a cat,’ she says, reaching into her pocket. ‘D’you want to see?’
She gets out her phone and scrolls through to a stout tortoiseshell-and-white in a red, diamante collar. ‘Say hello to Marilyn!’ says Jackie.
‘Oh!’ says Jean.
Arthur reaches up and rubs his chin on the corner of the phone.
‘Arthur and Marilyn!’ says Jackie, turning the phone to show him. ‘A perfect match!’

By the end of the consultation Jean and her daughter are as relaxed as Arthur. Once again I’m struck by how great Jackie is. As an occupational therapist she knows the trade as well as anyone. She can size a mopstick rail or a bathboard without even thinking. She knows how to turn the most unprepossessing living space into a workable therapeutic environment. But beyond the technical limits of the role there’s something else, something warmer and even more useful, perhaps. And that’s her ability to align herself with the patient and their family, to show them she’s not just some official person descending from who-knows-where to make changes they may not understand or even want. She’s a human being, like them. She’s on their side. And when that’s understood, anything’s possible.

I tell Jean what I’m going to do next, shake her hand and say goodbye.
‘See you back at the office’ I say to Jackie.
She smiles and waves, but her expression darkens a little. Ruth comes in with a cup of tea. The moment passes.
‘I’ve got a dog as well as a cat,’ says Jackie, brightening. ‘Wanna see?’
‘Ooh – what sort?’
I leave them to it.

When The Old Farmhouse was just The Farmhouse, when all the flints were freshly set in the walls, and the roof was still thatch, the busy main road just the other side of the hedge was probably just a track. Now, it would be impossible to find the place if Megan’s Great-Grandaughter Clarissa hadn’t come out to wave.
But once you’re through the gap in the hedge, the ground widens out nicely, the old house on one side of the lane, and dilapidated outbuildings scattered about in the undergrowth. Beyond the trees at the back you can just glimpse a tidier, more current world, with horseboxes and freshly-painted sheds; here, everything is slowly being subsumed by nature, the incoming tide of green that was kept back for years reasserting itself now, in its own order, and shape.
‘She should never have been discharged,’ says Clarissa, talking and checking her phone at the same time. She leads me up the steps that probably once doubled as a mounting-block, into the tiny house. Bare-boards. A dresser covered with ancient crockery, pictures, mementoes. An ancient radio that if you turned on would probably give you news about the war. Through to the back room, where Megan is lying in bed, asleep.
‘If only they’d kept her in a couple of days longer till Daddy got back,’ says Clarissa. ‘I just don’t think she’s ready for this.’
On the face of it, I’d have to agree. Megan’s been referred to our team for all the usual things, the health checks, equipment provision, intermediate care package and so on – but as she is now there’s nothing in the house to support her. It’s going to take a lot of intensive work to keep her safe, and this at a time of huge demand on the service. I can understand why Clarissa feels overwhelmed; I’m used to the scenario, and still I have to take a breath.
‘One step at a time,’ I say. ‘First thing I’ll do is check to see Megan’s okay in herself.’
‘I just started a new job,’ says Clarissa, helplessly. ‘It wouldn’t look good if I asked for some time off.’
‘Don’t worry. If you have to go, you have to go.’
‘I’ll stay a bit longer.’
She’s remarkably assured, given the stress of it all, but if she wasn’t wearing a leather jacket and clutching a phone, it feels as if she’d fly apart in a shower of sparks.
Megan’s observations aren’t great. Although for a frail old woman in her nineties who survived a fall, a long period on the floor, an acute MI, chest infection and three weeks in hospital, she’s remarkably cussed.
‘What are you doing?’ she snaps, grabbing the duvet back. ‘Leave me alone!’
An OT arrives to help. Between us we make what improvements we can, organising the care plan, liaising with the GP, investigating the possibility of a night sitter, tracking down the DNACPR and so on. It remains to be seen over the next few days whether a programme of rehabilitation is feasible, or whether this is more end of life care. Based on her condition, I would have said the latter, although it’s possible she’ll pick up when the trauma of the discharge home has passed. It’s hard to say. Once she’s rested, I’m sure Megan will be able to put her view across.
‘She was always one of those mad old women, even when she was younger,’ says Clarissa. ‘You know – the kind that shakes their stick for no apparent reason.’ She checks her phone again, and then finally puts it away. ‘She’s been great, though. I hate to see her like this.’

I walk with Clarissa to the door. The sun is so bright it takes a moment to adjust. After the muted gloom of the interior, everything is sharp, too intensely green.
‘She was born here, you know,’ she says. ‘Lived here all her life. Imagine that.’
We both look around. I can see Megan pulling on her boots to play with the dog in the snow, or dashing out in the early sunshine to feed the chickens, or any of the hundreds of chores she’d have had on the farm. Now it’s pretty quiet, nothing much happening, just Megan asleep in the back room, her breathing harsh and quick, the traffic endlessly rushing backwards and forwards on the busy main road a thousand miles away just the other side of the hedge.

A couple of days later I’m back to see Jeremy for a follow-up appointment. There’s a van parked outside, sheets laid out on the paving slabs underneath the windows and around the front door, and two sun-burned guys in overalls sitting on the garden wall, smoking. The oldest one, Terry, has long grey hair tied back in a pony-tail and leathery brown skin; his assistant, Mick, is a younger version, looking more like a painting and decorating marine, with a shaved head and tattoos you can barely make out beyond the tan.
‘He’s upstairs,’ says Terry, licking along the edge of his roll-up, nodding instead of pointing. ‘Pauline’s nipped out to the shops.’
‘Mind as you go in,’ says Mick. ‘Don’t touch nothing.’

Inside, the door between the kitchen and the rest of the house is shut. As soon as I open it, a blurred white shape races out.
‘Shit! Brian…’
The dog has run straight out into the back garden. He stands out on the sunny decking and watches me to see what I’ll do next. When I take a step towards him, he takes a step back. I crouch down, hold my hand out, lower my head submissively and make kissy-kissy noises; when I look up again, he’s standing exactly as he was, his head crooked slightly on one side.
‘Brian…?’
His ears prick up.
‘Come on, Brian! Let’s see who’s upstairs….’
He turns round and trots off into the garden.

The first thing I do is go outside again and speak to the painters.
‘Ah – don’t worry,’ says Terry. ‘He’s all right in the back garden. He can’t get out. It’s the front you’ve got to worry about.’
‘But we can’t shut the front door. It’s wet.’
‘Yeah – but – we can put this plastic table across the front…’
Mick produces a flattened white plastic garden table and props it up against the kitchen cabinets.
‘And I’ll secure it with these saucepans,’ says Terry. ‘How’s that?’
I go up to see Jeremy, leaving the connecting door open in the hope that Brian will follow.
He doesn’t.

Jeremy’s much the same as before. But despite his illness he’s warm and welcoming. When I tell him about Brian he bats the air.
‘Oh well,’ he says. ‘So long as the garden gate’s shut,’ he says. ‘It is shut, isn’t it?’
I go back down to check.

Brian is parading round the far side of the garden like he’s at a show.
I check the gate. It’s firmly closed.
I try a few more tricks to coax Brian over – ‘innocently walking away’ – ‘finding something interesting in the flower bed’ – ‘putting my hand in my pocket and saying what’s this?’ – but each attempt is treated with equal disdain. Seriously? Did you honestly think I’d be persuaded by such amateurish tricks? How little you know me.
I give up and go back inside.

Ten minutes later I’m halfway through the examination when I hear a cry from the kitchen.
‘Pauline!’ says Jeremy.
I tear off my stethoscope and hurry back down.
There are two shopping bags in the middle of the floor; the plastic table is angled away from the door, the saucepans are up on the counter, and on the freshly-painted wooden step, two neat paw prints.

Terry is rolling himself another fag.
‘It’s all gone tits up, mate’ he says. ‘I was round the side, Mick was in the van, and we didn’t see Pauline come back from the shops. ‘Course as soon as she moved the table Brian ran out. He’s high-tailed it down the road, Mick’s gone after him, and I think Pauline’s heading them off at the pass.’
‘Do you think I should have a drive round?’
‘Nah! They’ll be all right,’ he says. ‘Brian’s got previous. He always comes back.’
But then he spoils it by saying: ‘He’s a smart dog all right. I reckon he’s been planning this. I wouldn’t mind betting he’s got a system of tunnels, like in that film.’
He plants the fag in his mouth and wanders around the driveway shaking the legs of his overalls to illustrate how Brian got rid of the soil.
‘Yep. A very smart dog. Mind you,’ he says, taking the fag out again and picking a strand of tobacco from his bottom lip, ‘it wouldn’t be so bad if he had the road sense to match.’

I go back upstairs to tell Jeremy the bad news.
‘That dog’ll be the death of me,’ he says. ‘But don’t worry. I’m sure he’ll be fine.’
He doesn’t seem easy about it, though. And neither am I.
I finish the exam.
Just as I’m writing up the results, I hear a commotion down in the kitchen. Pauline’s back, with Brian on a lead, frowning and looking furious.
‘I’m so sorry,’ I tell her. ‘I didn’t think. As soon as I opened the door he was off.’
Brian looks up at me.
Snitch he says.

As Pauline leads me through the house she fills me in on Jeremy’s past medical history. The operations and treatments, consultations and confirmations, missed appointments and misunderstandings. Things had picked up for a while, she says, but then three weeks ago Jeremy’s health took a marked downward turn, and now here we are, confined to bed, awaiting developments.
We’re accompanied up the stairs by their little dog, Brian.
‘We didn’t call him that,’ she says. ‘But he’s seven and we thought it’s too late to do anything about it.’
I don’t tell Pauline, but I wouldn’t say he looks like a Brian. He’s such a curious mongrel mix, though, I’m not sure what would work. The tight white curls of a sheep. The soft black eyes of a seal pup. The spindly legs of a Windsor chair. At a push I’d say he was more of a Barnaby.
‘Through here,’ says Pauline, stopping on the landing.
Brian stands behind her and gives me a look.

Even from here I can tell Jeremy’s very unwell. His skin has a grey quality, his nose pinched, the prominence of his mouth, the hollows of his eyes – everything a testament to disease and decline. I was told before I came out there were anomalies on the most recent chest x-ray. I wonder what conversations they’ve had on the subject, and I’m conscious of the words I should use.
Despite his sickness, though, Jeremy’s pretty chipper. He jokes about getting caught in the crossfire between the GP and consultant, about the tragic-comedy of the patient transport service, and most particularly, about his fervent desire never to set foot in another hospital again.
‘It’s the endless waiting around! Days pass into weeks, and let me tell you – you really start to notice the cracks! No thank you. I’d far rather take my chances here. What d’you think, Brian?’
Brian responds to his name, sits back on his haunches and angles his head up at Jeremy. Then after a moment he looks round and rests his eyes on me. He’s such a funny little dog, and the room is so bright and peaceful, I wouldn’t be all that surprised if he put a paw to his muzzle, cleared his throat and spoke.
I’d really appreciate it if you could do something for Jeremy. I’ve grown rather attached to the old chap, and I’d hate to see him suffer.
I get my obs kit out, loop the steth around my neck, and open Jeremy’s folder to the obs page.
‘Okay Brian,’ I say. ‘Let’s have a look…’

In an average day I’ll see six or seven patients. Sometimes the contrast between their situations is so striking it’s like I’m dealing cards from an NHS-themed tarot pack: The Wronged Man. The Fool. Fortitude. King of Catheters. Death.

For example, my first patient: The Sofa.

It’s not only Stanley’s bloods that are deranged. The carpet is covered with discarded newspapers, letters, flyers, menus, books, crisp packets, remote controls, glasses and a hundred other things. At the heart of it all is the sofa where Stanley has been sleeping and living the past few months, the uncovered duvet thrown back, pillows yellowing, the whole thing looking like a burst artillery shell of loneliness.

Stanley has chronic kidney disease, diabetes. The renal unit call him in once a month to review his bloods. He’s at that liminal stage where the slightest movement south on his U&Es will mean he has to start dialysis. For now, he’s getting by the best he can at home. Getting a taxi to take him shopping, occasionally, although that’s been impossible the last week or so (as the pile of empty microwave meal containers in the sink testifies). Beyond his usual ill health, it’s hard to establish what’s acutely different, though. His bloods are poor, but nothing more than normal.
‘I just feel so exhausted all the time,’ he says.
‘Is there anyone around who could help out?’ I ask him. ‘Family, friends…?’
‘No. There’s no-one.’
Our job as the Rapid Response team is to get him back to something approximating normal. A guy to come in and clean the place up. Carers to do his shopping, make his meals and help him with washing and dressing. A Mental Health nurse to assess his state of mind. A pharmacist to review his obs. OTs to put in equipment. Physios for an exercise regime. Nurses to review his obs and liaise with the GP. We’ll do the best we can, but sometimes it’s overwhelming. Stanley didn’t end up like this in a matter of days or weeks. The breakdown in social connection often takes years to work its way out like this, into these extremes of social isolation.
‘What do you need from the shop?’ I ask him.
He gives me a list, and a ten pound note.

And then on to the second patient. Queen of Trolleys.

I haven’t been here before. A lovely block of flats, immaculate gardens, and the kind of residents who seem comfortable saying hello.
I’ve come to see Agnes. It’s a very temporary referral. The only reason she’s on our books is because of some strange, unanticipated failure in her care package. I don’t know the ins and outs, but I don’t get the feeling we’ll be coming in long.
Getting access to Agnes’ front door is a major intelligence test. In the end I have to call Agnes’ daughter, who explains that I have to retrieve a key from the lintel in the hallway, use that to open a service door, and then locate and open a keysafe.
‘All right?’ she says. ‘Found it?’
‘Yep! Thanks very much.’
‘Call me if you need anything else. And thank you for stopping by today.’
I let myself in.
A welcoming, meticulously tidy flat.
Agnes is in the living room, watching Loose Women. They’re sharing their wedding experiences, which Agnes watches with an open mouth. Her wedding photo is just by her on the bookshelf, but it’s not something she acknowledges.
I’m there to make her something to eat. Everything’s laid out – the ready meal, the dessert, instructions on how to use the microwave – in fact, carefully written instructions taped on just about everything, from the front door to the fridge and cooker. The butler sink has a scrubbed look, with a laundered tea towel draped on a rail and a selection of cutlery laid out in neat lines.
Whilst I’m waiting for the cottage pie to turn through its minutes, Agnes appears at the doorway, pushing her kitchen trolley. On the trolley is a little knitted bear, a remote control, and a box of tissues.
‘Are you all right, Agnes? What can I get you?’
She stares at me for a moment, then makes an approximate kind of smile.

‘Oh – nothing. Nothing, really.’
‘Lunch is almost ready. Would you like a cup of tea with it?’

‘That would be … erm… yes. Yes, please.’
She turns and heads back to her seat.

Back out in my car, I write down the time, cross through Agnes, locate the next call.
I turn the wheel, and move off.

I flip the card.

Aileen is lying on the bed with one arm crooked up over her eyes.
‘This can’t go on,’ says Jackie, her sister-in-law. ‘I mean, look at her. Paula’s got enough on her plate as it is.’
Paula is Aileen’s elder sister. She smiles and shakes her head. ‘I’d like to do more,’ she says. ‘But it’s not the world’s biggest flat, as you can see, and David’s laid up with his back.’
‘I’d just like to know what you think you’re going to do about it,’ says Jackie, leaning forward for emphasis. ‘I’m sorry. I’ve got to say it how it is. One of the nurses told me, in confidence. She said you won’t get anything without making a fuss, darling. And she was right. We’ve tried playing along, it hasn’t got us anywhere, so now I’m damn well going to make a fuss.’
‘It’s okay, Jackie,’ says Paula.
‘No it isn’t!’

I haven’t met any of them before. I’ve been sent to conduct the basic health screen, and as usual, all I’ve been given are the basic facts: seventy-eight year old, multiple ambulance call-outs with shortness of breath, anxiety, abdo pain. All Aileen’s obs are fine. I’ve taken some blood, dipped her urine, and now I’m writing up the results. It’s a stressful situation, difficult to negotiate, particularly as there’s a great deal of back-story I just don’t know.

Aileen starts to cry again. Paula sits next to her on the bed and rubs her shoulder in a straight-armed kind of way.
‘Seriously though,’ says Jackie. ‘This can’t go on. We’ve been promised this, that and the other before, and nothing ever happens. She can’t go home like this. She needs someone to sit with her tonight. The family can’t do it no more. We’re all exhausted. I mean, we appreciate you coming out and everything, but who’s to say you won’t be like everyone else and promise things that never materialise?’
‘I’m sorry you’ve had bad experiences in the past, and you’re right, it can’t go on like this. Our focus is to prevent people going in to hospital unnecessarily, so we’ll do everything we can. But I’ll be honest with you, Jackie – night sitters are in huge demand, and we don’t have access to that many in the first place.’
‘Well there you go.’
She sits back and folds her arms.
‘It’s a funding issue,’ I tell her. ‘With all the cut-backs there just isn’t the money. So things like night sitters get rationed pretty tight, and they tend to go to those patients with really acute medical needs.’
‘It shouldn’t be like this,’ says Jackie.
‘Absolutely. It shouldn’t. But I’d rather be realistic about what you can expect. Anyway, looking on the bright side, there’s still lots we can do.’
‘Oh yeah? Like what?’
‘Like making sure that physically everything’s okay. That’s why I did all those tests. Then I can get one of our social workers to talk to you about your living situation. That’s another thing. And if you need some care support in the short term, people popping in to make sure Aileen’s okay, eating and drinking, taking meds and the rest of it – we can sort that out, too. And I can ask one of our mental health nurses to come and talk to you.’
Aileen suddenly pushes herself away from Paula into a sitting position.
‘Mental health? What does he mean, mental health? He’s not going to put me in one of them places, is he? I’m not sick in my head, am I?’
She groans and presses her fists to her temples.
‘Try not to get yourself worked up, Aileen,’ says Paula.
‘It’s okay, Aileen. There’s nothing to worry about. It’s just someone with special training who can talk to you about how you’re feeling. And you know – lots of people have problems with things like anxiety and depression. Some really famous people have struggled with it. Winston Churchill used to get depressed. I think he called it his black dog. But he did all right, didn’t he? Churchill?’
‘I wonder how he did cope,’ says Paula, gently picking some loose strands of hair away from Aileen’s face.
‘Brandy and cigars, weren’t it?’ says Jackie. ‘Maybe you should write her a scrip for that.’

Harold is bearing up pretty well, considering he’s ninety, and fell all the way down the stairs a couple of weeks ago.
‘I managed to get him up,’ says his wife, Janice, perched on the arm of his chair. ‘I used three stools – one small, one medium, one large. But I have to say I’m feeling it a bit now.’
They didn’t call the ambulance. Instead, Janice bathed his head, gave him paracetamol, and helped him get about over the next few days. When that grew too much, she called in the GP, who, after deciding Harold’s back pain was probably musculo-skeletal, and ruling out any need for an X-ray, referred Harold on to us.
‘I must say I’m impressed,’ says Harold. ‘I had no idea this kind of thing was out there.’
He smiles in brief flashes, as if his teeth are too big for his mouth, and he’s worried they’ll pop out into his lap.

All the tests I run are fine. Whilst I write up the results, Harold tells me about the time he fell over in the street a year ago.
‘Not quite as spectacular as the stairs,’ he says. ‘This time it was a tree root. You know how they push up through the pavement and make everything humpity-bumpity? Well that’s what did for me. And this is the result…’
He holds his left hand in the air and turns it this way and that. I can’t see anything wrong with it, but I tut all the same.
‘The pain you feel in your back, Harold. If you had to give it a mark out of ten, with ten being the worst and nought being none, what would you give it?’
I hold my fingers horizontally and move my hand up and down like a gauge. ‘Marks out of ten for the pain, Harold.’
‘Nought when I’m sitting still like this, ten when I’m walking about.’
I write it down.
‘And may I say,’ he says, smiling broadly, and then pressing his lips together again. ‘I very much enjoy your concision.’

Turns out, the Old Bakery Mews is a densely-packed development of chi-chi flats on the waste ground behind (wild guess) what used to be the bakery. The flint walls and red-bricked fascias are nicely done, but they have that earnest, rather stilted feel that high-end new-builds are prone to. Maybe it’ll work in a hundred years; for now, it just looks fake.
I park up, and head towards number twenty-two, struggling under my usual burden of rucksack, weighing scales, yellow folder and diary.
‘All right?’ says a man in black, standing at the door of a business that backs on to the car park.
‘Yep. Fine. How are you?’
‘You’re not parking there,’ he says.
‘I’m a health visitor. From the hospital,’ I say. Then add, a little pathetically, ‘There’s a sick person who needs help.’
‘Private property,’ he says. ‘You’ll have to move it.’

It’s one of the occupational hazards of working in the community, of course. Back pain. Needlesticks. Parking. I’m quite prepared to compromise on the parking, of course, but sometimes there’s very little practical alternative. Each time I’m confronted with that I don’t make the rules attitude, I’m overwhelmed with the same sense of injustice. The world’s difficult enough, for God’s sake, without these petty demonstrations of property law.
I go over to him.
‘What if it was someone in your family who was sick?’ I tell him. ‘How would you feel then?’
‘I’m going to make a phone call,’ he says.
‘Good. You do that.’
I follow him to the back door.
Inside, a young woman is typing. She risks a glance in my direction. A rough-haired lurcher gets up out of its basket and heads in my direction. She grabs its collar.
‘No, Trampus!’ she says.
‘It’s okay,’ I tell her, putting my stuff down. ‘I like dogs.’
She lets him go; Trampus trots over and gives me a thoroughgoing sniff. He helps me calm down, though I can’t think for the life of me think how such a lovely dog can exist in the same room as the Man in Black without reverting to wolf and tearing his throat out.
Meanwhile, MiB is explaining the situation on the phone.
‘He says he’s from the hospital. The Hospital. Apparently there’s a sick woman somewhere. No! One! A sick woman. He says he wants to park here.’
‘Half an hour, max,’ I tell him.
‘Half an hour, he says….. Max. No, Maximum. Hang on, I’ll ask him.’
He puts his hand over the mouthpiece.
‘Who did you say you worked for again?’
‘The Rapid Response Service.’
He relays that to the person on the other end, someone who I can only imagine lives in a castle decorated with skulls and pelts and a hundred other souvenirs of their long and compassionate time on earth.
Trampus goes back to his basket.
‘You’d think it’d be all right just for half an hour,’ I say to the girl. ‘Imagine if it was someone in your family who needed help.’
‘Yeah, but we don’t make the rules,’ she says. ‘It’s private round here.’
MiB puts the phone down and walks over again.
‘Move it,’ he says.

I’m wearing overshoes, an apron and a pair of gloves, and still it doesn’t feel enough. Mind you, Gladys and Henry’s house is so dreadful, I’d probably feel twitchy in a biochem suit.

Henry is supposed to be looking after Gladys, but his health has taken a turn for the worse and nothing’s been done for a good long while. They’ve been referred to social services in the past, but each time they’ve declined any interventions or meaningful packages of care. They have full mental capacity, so of course they’re entitled to live how they want. And if that means repeated ambulance call-outs for falls amongst the clutter, or acute episodes of diarrhoea and vomiting, well that’s just the price the wider community has to pay for their refusal to accept help in the longer term. They’re trying to be independent, and that’s a good thing. Except, they’re not succeeding. And not only is it harder to put things right when they’ve gone so wrong, the cost of providing acute interventions is higher than if they’d accepted more timely help.

To hear Henry talk, you’d think there wasn’t anything particularly amiss.
‘Things ‘ave gone a bit to cock,’ he says, scratching his head. ‘I can usually make it on the bus to go down the supermarket for the ready meals and whatnot, but I ‘int been able to do that lately what with my hip and everything. And then the neighbour who sometimes brings stuff in has gone on holiday. And so has my son! So we’re up the creek without a paddle.’

He lies back on the bed.
‘You couldn’t get me some toast or something, could you? I’m starving.’

Which is why I’m heading to the fridge.

My overshoes are almost pulled off step by step as I walk across the kitchen floor. There are mounds of unwashed crockery, exposed food in dishes that were probably microwaved weeks ago and then abandoned. Decrepit salads partially covered in tin foil. Half a can of chicken in white sauce, chuckling with bacteria. And there, standing in the corner of all this horror, the crowned Prince of Carnage, Glady and Henry’s fridge.

Even the flies don’t seem confident. They fly towards it, cut a ninety degree turn, head towards it again, cut back…

I bat them away, reach out a hand, and open the fridge door.

I remember reading about the labours of Hercules. One was to kill a particular lion, one was to kill the Hydra, one was to stop the NHS from being privatised, I think – and one was to clean out a gigantic stables filled with horses and cows and so on. But Hercules was smart as well as strong. He used his lion-hatted head, and diverted a nearby river to run through the stables, flushing them out.

Well. It sounds like that was pretty effective.
But standing here, gacking in front of this fridge, I’m here to tell you, Herk. You’re going to need a bigger river.

There’s certainly no shortage of game shows. There must be a factory somewhere, a giant warehouse, with a fork-lift backing up day and night with crates of flat-pack sets, catering-size tubs of contestants, and – arriving by special courier – cartons of snap-fit hosts (a specialist team to assemble – “I think we’ll have another Mockney male. This suit, that tie, those eyes.”). The show Lily’s watching seems to be based on safe cracking. God knows what happens if they get the code right. Meanwhile, the Host ruthlessly corals his nerds with one eye on the camera and one on the studio clock, looking so stiff if you tore his shirt open you’d probably spill cogs.
‘Dame Judi Dench,’ says one of the contestants, choosing a category (I didn’t catch the theme – Bond characters? People with a life?)
‘Dame Judi Dench!’ says the Host. ‘Good ol’ Dame Judi.’
He raises his hand and a digital clock starts running.
Lily is avidly watching the show from the ruin of her armchair. It’s just as well the room is super-heated – she’s surrounded by three, free-standing radiators, all turned up to the max – because Lily is naked, her fingers laced across her flaccid breasts, one leg jauntily crossed over the other, head craning forward, bottom lip curled up in an expression of extreme concentration.
She looks over at me.
‘Hello Lily!’ I say.

*

The bright morning sun still hasn’t penetrated the gloom at the bottom of the basement steps. It’s so chill down here I wonder if it ever does.
The front door is blistered, battered. There are three notices roughly taped-up to make them waterproof and then thumb-tacked into the panels:
YOU HAVN’T BEN INVITD SO KEEP OUT!!!!
THE BELL DONT WORK. IF I DONT COME WHEN YOU KNOCK GO AWAY YOUR NOT WANTED!!!
THIS IS PRIVIT PROPERTY!!! IF YOU COME IN WITHOUT PERMISHON YOURLL GET WHAT FOR!!!
There’s a keysafe, though. I retrieve the key, open the door and peer inside.
A long corridor, banked up with junk on the left hand side, doors leading off on the right. All dark, except a light on in what must be the kitchen at the far end.
‘Hello? It’s Jim from the Rapid Response. From the hospital. Come to see Lily.’
No voice in reply, just the muted blare of a TV in a room further along, near the kitchen.
‘Helloooo? Rapid Response…’
I leave the door open, thinking it’ll be quicker to run out if I have to.
What makes the whole thing worse, of course, is that strictly speaking, I don’t have PERMISHON. But then, the referral from the hospital was quite unequivocal – not coping at home, hallucinating, ?capacity, needs urgent assessment. Sometimes there only seems to be a fine, legal margin between ‘Best Interest’ and ‘Breaking & Entering’; I’m tiptoeing along it now.
‘Helloooo?’
I glance into each room as I pass, just in case. I’m like a character in a bad thriller – hopefully the hero, but knowing my luck, probably the guy who gets whacked in the first scene and put in a freezer.
‘Hellooo? Lily?’
The TV gets louder as I move down the corridor. She must be in there. So many of the patients I visit have hearing problems and sit close to the TV with the volume up. But those notices on the front door have made me jumpy.
I knock on the closed door and after a pause, gently push it open.
‘Hellooo?’
A wave of heat and sound.
Now I understand you’re in MENSA?
– That’s right
That sounds fascinating. So tell me – what do you have to do to get into a thing like that? Apart from be very very brainy of course?
– Well. Erm. No. That’s about it.
I see! Great. Well see just how well those brains are working for you today as we go into the next round…
Lily looks at me from the armchair.
‘Can you help me to the toilet?’ she says, gesturing vaguely to a dustbin in the corner of the room.
‘The dustbin? You’re not going to the loo there, are you Lily?’
‘No-one’s told me where the proper loo is.’
‘I can show you, if you like.’
‘Will you?’
‘Of course. Let’s put a dressing gown on you first.
On the way there I try to get an idea of her situation. Someone obviously comes in now and again. Her tablets are up in a blue crate on top of the kitchen cabinets; there’s a pack of fortifying drinks on the side (untouched); some unused pressure area equipment. Notes in a different, more moderate hand on the fridge, reminders of what’s in there, when to eat, when Barry’s next in. A phone number (I write it down).
‘How long have you lived here, Lily?’ I ask as I help her back into the front room.
‘Ooh, not long. I’ll tell you what happened. I got pregnant and they didn’t want me to keep it. But I did, you see. I did. I kept the child, and I worked – I worked damned hard – all my life. And the next thing you know, they’ve packed me off to this place.’
She pinches my arm and leans in.
‘Don’t let them,’ she says. ‘Don’t let them leave me here.’
‘I’ll see what I can do.’
I help her back into the armchair. Bring her a mug of tea with some biscuits. There’s a knock on the front door. A community mental health nurse has arrived. I give him a quick handover, then introduce him to Lily.
It seems the MENSA guy hasn’t been able to crack the code. He looks shamefaced as the Host wraps things up.
‘Sadly this is the point we have to say goodbye,’ he says. ‘But you’ve been a smashing contestant. Please give my very best to the good people of MENSA, and tell ‘em the application’s in the post. Okay then? All right! A big hand ladies and gentleman!’
I say goodbye to Lily, but she looks at me with the same bewildered expression she’s been giving the TV.
‘Who’s that?’ I hear her say to the nurse.
‘It’s Jim. A colleague,’ he says.

Outside, walking back up the basement steps into the sunshine, everything feels so overwhelmingly fresh and sharp I stop when I reach the pavement and look around.
I see an elderly woman holding onto the railings whilst she gets her breath; a guy washing windows with a squeegee on the end of a ridiculously long pole, and two guys talking intensely, argument or agreement it’s hard to say. One of them has an Irish terrier on a lead. The terrier is staring at me, quivering intently, its tail arched over its body in my direction like some kind of transmitter. The guy holding the lead suddenly jerks it a little; the terrier’s paws skitter delicately on the pavement, and it ends up pointing the other way, at the man with the squeegee. If the men don’t move soon, they’ll get wet, I think. Squeegee man will have to say something. Why are they leaving it so late?

Meanwhile, the old woman has walked off.

I load my stuff into the car, cross Lily off the list, and drive.