Even though I’d been given the heads up about Mr Jackson and the reason behind the strictly male only policy on his care plan, it’s still a shock to walk into his kitchen. The walls are covered with a dreadful mural – hundreds of images of naked women, carefully cut-around and arranged, all angles, one on top of the other. I feel like I’ve been black-magicked, miniaturised and dropped by the scruff of my neck into the skull of a pornographer.

Mr Jackson is waiting for me in the kitchen, sitting on a low, fabric and wood armchair, his bony elbows planted on the armrests, his chin resting on his hands, one leg crossed over the other, the top foot patiently tapping.

It’s a basement flat, and the kitchen is only dimly illuminated by whatever light makes it down through the overgrown garden.
I reach for the light switch; he asks me not to.
‘See that little switch there?’ he says. ‘Put that on instead, would you?’
It illuminates two bare bulbs that flicker like candles to the right and left of a long shelf running beneath the largest section of mural.
‘Thank you’
The kitchen is infernally hot, which makes it all worse.
‘Did you know one of the rings on your cooker’s on?’ I ask him.
‘Of course I fucking know!’ he says. ‘I should do! I’ve lived here forty years!’
But then he separates his hands and lightly claps them together again, smiling with a slick and grey expression that reminds me of Gary Oldman in Dracula.
‘I’m joking, of course!’
Before I do the examination I ask him if he’d like a cup of tea.
‘No,’ he says. ‘It’s not simply a question of dabbling a tea bag in a mug. There’s a complicated ceremony and it’s not worth going through it all now. Could I have a glass of water instead?’
‘Sure. Tap or bottle?’
‘This is England!’ he says. ‘The water’s filtered God knows how many times. Not like other places where you’d be scared to take a piss in it.’
I run the tap a moment and fill him a glass.
‘Not that glass. The other one. No – that one. The decorated one. No – the other decorated one. Thank you.’
He sips the water.
‘What about breakfast?’ I ask him.
‘A little banana, sliced in a bowl,’ he says. ‘I have to watch what I eat.’

Maurice peers round the door.
‘And who did you say you were again?’
‘Jim.’ I hold out my ID. ‘From the Rapid Response Team at the hospital. I’m a nursing assistant.’
‘I didn’t warrant an actual nurse, then?’
I laugh, a little awkwardly, immediately wishing I could do or say something more reassuring. It doesn’t seem to matter, though.
‘I suppose you’d better come in,’ he says, releasing the door.
I follow him down the hallway. The exaggerated forward curve of Maurice’s spine makes walking difficult. He can only manage it by shuffling his slippers along the parquet floor, paddling his hands backwards and forwards for extra oomph, and trailing his fingers along the route at familiar points – the telephone stand, the bookcase, and the huge fern in the jardinière, which rocks so alarmingly I feel obliged to put a hand to it myself.
‘Never mind that,’ he says, getting himself into position. ‘Take a seat,’ immediately pitching himself backwards into a decrepit armchair, his arms tucked in, like a Scuba diver dropping off the side of a boat.
‘Thanks.’
When he’s settled, he laces his bony fingers across his belly and regards me with a long and lugubrious expression.
‘Now. Explain to me why you’ve come.’
‘Your GP has referred you to us, Maurice. I think she’s worried you might need more help at home.’
‘And you’ve come to provide me with that help, have you?’
‘In a way.’
‘Well either you have or you haven’t.’
‘You see, when anyone’s referred to us, for whatever reason, they get a health check, to make sure they’re okay, and there are no immediate medical issues to worry about. That’s where I come in. Then one of my colleagues will come along to finish the assessment, and they’ll be the ones looking at things like equipment, physiotherapy, and whether you need any care…’
He  sighs, and narrows his eyes.
‘When did it start with all this first name business?’ he says.
‘Oh. I’m sorry. That’s very rude of me. Would you prefer it if I called you by your last name?’
He shrugs, lifting both thumbs at the same time for emphasis.
‘It’s the modern way,’ he says, relaxing again. ‘I suppose it has a superficial mateyness. It doesn’t mean anything, though. And in a curious fashion it makes things feel even more anonymous. D’you follow?’
‘I think so.’
‘And you’re Jim did you say?’
‘Yes. And when you think how many Jims there are! Thousands! No wonder it’s confusing.’
‘I didn’t say it was confusing, Jim. I said it was the fashion. And I’m far too old to do anything about it.’
‘How about I make you a nice cup of tea? To make amends.’
‘That would be kind.’
‘How do you take it?’
‘Two, please.’
‘Sugars?’
‘No! Bags. I like it strong. There’s some UHT milk in the fridge. If that’s gone off I can drink it black.’
‘Anything to eat?’
‘No thank you.’
He sniffs.
‘I have no appetite these days,’ he says.

Despite that, his kitchen is extremely well-stocked. Maurice tells me a friend of his comes round every now and again to do a top-up.
‘I don’t like to bother him,’ he says as I come back in with the tea, and he points to a place mat. ‘I mean – between you and me – if I was him, I just couldn’t be doing with someone like me. Is that an awful thing to say?’
‘Not awful. A little sad, maybe. And I’m sure that’s not the case. I’m sure he’s perfectly happy to come round and make sure you have what you need.’
He doesn’t say anything, but I can tell he doesn’t agree.

The tea was a good idea, though. It warms him up in more ways than one. He tells me how lonely he is, how he doesn’t see anyone for days on end, how he finds himself talking to inanimate things like they’re people.
‘I’m not potty,’ he says. ‘It’s just – long periods alone can send you doolally. I suppose the simple fact is,’ he says, placing the cup back in the saucer with exaggerated care, ‘I’m just too old.’
I ask him if he has any family.
‘Not anymore,’ he says. ‘I’m the last of a rather short line. I only had one sister, you see. Younger than me. She had what these days they call mental health issues. Always in and out of one place or another. I remember saying to the doctor, I said to him What on earth’s the matter with her? And he said to me We simply don’t know. Just like that. We simply don’t know. And of course, what I should have asked him was: Well if  you don’t know, why don’t you find someone who does? But one can’t say these things, can one? Eventually she died. Of cancer.’
He studies me mournfully, the lower edge of his eyes suddenly lined with silver. ‘And that’s another thing they missed,’ he says.

Katya is lying in bed, propped up on pillows, leaning to the right. She has a disposable, white pen torch in her hand, and she’s repeatedly pressing the clip of it to work the light, making the tip glow and fade and glow again. She stares at the light intently, like she’s messaging some deeper part of her brain.
‘The paramedics gave it to her,’ says Pawel, her son. ‘I suppose it’s a distraction…’
‘She seems comfortable.’
He nods.
‘Something to be thankful for,’ he says.
Katya is ninety-eight. She’s had health problems in the past, but this last year has been particularly hard. She’s struggled to recover from pneumonia, her eating and drinking have diminished and her kidney function has tailed off, taking everything else with it. All in all it’s fair to say she’s in poor shape. I review her obs on the chart.
‘Hmm,’ I say, like a bad mechanic, rubbing his chin.
‘What do you think?’ says Pawel. ‘What shall we do?’
Katya flicks the torch off and on.

It surprises me that she’s been discharged from hospital without anyone having a conversation with the family about End of Life care. Without having had the time to build up a relationship with the patient and family, it’s extremely difficult as a community practitioner to walk in the door cold and talk about these things. End of Life is a sensitive area, fraught with complications and heightened emotion. As a result, people tend to shy clear of it, trusting that someone higher up the chain, or further out, someone more experienced in these things, someone with a thicker skin, perhaps, someone on a higher pay band, will broach the subject and ‘manage expectations.’ The majority of families look to medical professionals for guidance. If it’s not forthcoming, they’ll imagine there’s more that can be done, more drugs to try, more procedures to undergo. The result is – almost inevitably – the patient ends up dying on a trolley in A&E. It’s such a shame, and so avoidable.

Sometimes, in these situations, I wish there was an End of Life equivalent of the maternity Doula. I used to come across them as an EMT in the ambulance. They were people who’d been hired by the woman to look after her interests when she went into labour, to act as an advocate for her birthing plan, at a time when she might not be in the right state of mind to speak up for herself. It was all nicely worked out beforehand, and helped enormously. A Death Doula might serve a similar function, acting as an End of Life advocate, making sure everyone was clear about what was happening, what was expected, a steady point of contact between the family and the clinical and care teams, and giving the family a break when they needed time away. Birth and death have a lot in common. They’re both liminal states, a transition from one form to another. They’ve become hyper-medicalised, and something has been lost in the process.

‘So what d’you think?’ says Pawel.
‘Katya’s really not well, but I think it’s a shame just to turn her round and send her straight back to hospital.’
‘Absolutely.’
‘So – we need to have a think. And a chat to her GP. D’you mind if I use your phone?’
‘Sure. Through here.’
I turn back to Katya to say that I’m leaving, and it’s been lovely to meet her.
She doesn’t respond, though, distracted as she is by the flickering white light in her hand.

You wouldn’t need a doctor to tell you Tommy is dying. And exactly what he’s dying of is anyone’s guess. For whatever reason, Tommy has consistently refused any treatments or investigations, opting instead for a slow decline at home. These last few weeks his friend Mick has been looking after him on his own; now, things have taken a turn for the worse, and Tommy needs caring for in bed. The GP has referred him to us in the short-term, to handle the immediate care and equipment needs, and to the District Nurses, to case manage in the closing days or weeks. We’ve managed to install a hospital bed with a dynamic mattress, slide sheets and other equipment, provided carers to double-up with Mick; anticipatory meds are pending, and a DNACPR is in place. There’s not too much else to be done but monitor, make comfortable, and wait.
Tommy is lucky to have Mick. A neat, level kind of guy with a smile as frank as his handshake, he has that rare skill of being able to talk directly without seeming bossy or hard-edged. Tommy’s basement flat had been a little chaotic to begin with, and it’s amazing to see what improvements Mick has made in such a short amount of time. He’s managed to arrange things just-so, enough room for the carers to work safely, without anyone losing sight of the fact that it’s Tommy’s home, a place he wants to die in, with his things around. To help keep everyone on track, Mick has discreetly pinned up lists of essential information. The nursing folder’s in good order, with the DNACPR form readily accessible at the front.
He wakes Tommy by stroking the top of his arm and leaning in: ‘It’s Jim, Tommy. Come to see how you’re getting on.’
Tommy opens his eyes and turns his head, blindly.
‘Is there anything I can do for you this morning, Tommy?’ I say.
He manages to raise his right hand a little, and I take it, giving it a gentle squeeze. Then he relaxes back into the bed, and closes his eyes again.
‘There, look! You’ve worn him out!’ says Mick.

*

After the visit, making the steep climb back up the dark basement steps to street level, I feel like I’m emerging from the underworld. Everything’s so bright and active, so powerfully alive. Tommy has lived here fifty years, and I expect it’s always been busy, one of those high street tributaries, a mixture of shops and private flats, everything piled higgledy-piggledy, one on top of the other. The sun’s out, it’s lunchtime and the street is particularly frantic, workers out foraging on a lunch break, delivery vans delivering, scaffolders banging and shouting overhead, everyone with somewhere to go and going there quickly, some of them checking their phones as they walk. There’s one still point amongst the carnage, though – an old guy, sitting halfway down on a stoop, leaning against the railings with a sketchbook on his lap, drawing with a pencil. He certainly looks the part, in a battered fedora hat, linen jacket and scuffed brown shoes. I like the way his hat accentuates the tip of his head as he continually moves between the page and the street. I’m parked just a little way beyond, and as I walk by I can’t help glancing at what he’s drawn. It’s completely wild, a vigorous swirl of lines and rough shading, with everything in the street, the people and trees and cars and buildings, even the clouds – everything rushing together.
‘Looking good,’ I say.
He glances up at me and nods. And I might be wrong, but I have the distinct impression he sights me along his pencil as I walk past him to the car, and adds me to the chaos.

‘Who’s that in the photo?’
‘He saved my life.’
‘How d’you mean? Is he a doctor?’
‘No. He values things. I can’t remember what it’s called now. Begins with A’
‘Auctioneer?’
‘No.’
‘Actuary?’
‘No.’
‘So – how did he save your life?’
‘I collapsed in the street. He just happened to be walking past. He picked me up, and he took me to his home. And he kept me there for years. Wouldn’t let me work. He took care of everything. Yes – he was a great man. I think other men were frightened of him. It was the way he’d look at them. Very direct.’
‘How old were you at that point?’
‘I can’t remember. Thirty or so. I’d had a baby. But nobody knew what can happen to you when you’ve just had a baby. Not like now.’
‘What happened to the baby?’
‘It went to the orphanage. And that was another thing nobody knew about. Orphanages.’
Cheryl curls her lip, then takes another draw on the cigar she’s smoking, her yellowing face momentarily lost behind a cloud of smoke.
‘Assessor,’ she says. ‘That’s what he was.’

I’m just about to take Vera’s blood pressure when Riley starts barking – not loudly, it’s true, but bad enough to start Vera waving her arms, and trying to reach out to the side and bat him on the head.
‘It’s that dreadful cat again!’ she says. I unwrap the cuff and straightaway she hauls herself out of the chair and lurches over to join Riley at the window. (She’s put a worn leather pouffe for him there, low enough for his arthritic legs, high enough for him to see out). I stand behind them – and see a scraggy, black and white cat, sitting in the middle of the front path, slowly licking its paw. Riley keeps on barking, despite Vera’s attempts to stop him. She bangs on the window, too, so vigorously that she dislodges her wig and has to straighten it again. The cat’s not bothered by any of this, of course. It looks up from its paw, stares at us all in the window, then carries on attending to his paw.
‘You couldn’t go outside and get rid of him, could you?’ says Vera. ‘Only he’ll be there all morning and Riley won’t let up.’
‘Of course.’
As soon as I open the front door the cat stops licking its paw. Behind me, muted at the window, Riley huffs and coughs and growls, and I can tell by the way his shoulders bunch and relax that he’s paddling his front paws up and down on the pouffe.
‘Hey little fella!’ I say, bending down and reaching out a hand. The cat straightens, stretches, struts over tail in the air, sniffs my hand, then wraps himself round my legs.
I look back at the window. Vera makes encouraging shoo shoo gestures; Riley chokes with indignation.
‘Come on, cat,’ I say, picking him up. ‘You’re not helping.’
He’s strangely inert in my hands, like he’s well used to this kind of thing.
I carry him next door, gently pop him over the wall, and go back inside.
‘There!’ I say. ‘Mission accomplished!’
But no sooner have I closed the door than Riley is at the window, barking again.
‘He’s come straight back!’ says Vera. ‘You didn’t throw him far enough.’

When Vera finally answers the phone I tell her how relieved I am.
‘Sorry,’ she says. ‘I was chatting to Dolly. She’s my darling little sis’ and I love her to bits but she doesn’t half go on.’
‘I’m just glad everything’s all right, Vera.’
‘What d’you mean? Why wouldn’t it be?’
‘I was worried when I couldn’t get through. I thought you might have knocked the phone off the hook or something. I thought you might be lying on the floor.’
‘Well I did have a fall,’ she says. ‘But that was last year.’
‘I thought for a minute I might have to kick the door down.’
‘Kick the door down? Why would you do a thing like that?’
‘How else would I get in?’
‘I’d come and let you in.’
‘You wouldn’t be able to, not if you were on the floor.’
‘But I’m not on the floor.’
‘Anyway – you couldn’t come and let me in, could you? It’s absolutely freezing out here.’
‘Out where?’
‘Out here. Outside your front door. I’ve been ringing and knocking for the last twenty minutes.’
‘I haven’t heard anything.’
‘Never mind. Could you come and let me in?’
‘Well I’m looking out the window and I can’t see you.’
‘I’m at the front door.’
‘What do you mean, the front door?’
‘The door. At the front.’
And suddenly I realise what’s happened.
‘What number are you, Vera?’
‘Ninety. Why? What number are you?’
‘Eighty. Don’t worry. I’ll be with you shortly.’
‘Righto.’

A minute later I walk through a gap in a large privet hedge and see Vera waiting on the step with her ancient bull terrier Riley. The only difference between them – apart from height and number of legs – is that Vera is wearing a wig (apparently made of straw, and tilted at an angle, like a bonnet put on in a hurry), and Riley is completely bald.
‘There he is!’ says Vera, leaning down to tap Riley on the head.
Riley stiffens, leans forward to focus, then after giving me a wheezy kind of bark, pushes himself up, and turns to lead us all inside.
‘I bet you’re glad you didn’t go kicking down any doors,’ says Vera.
‘Oh – I would’ve tried a few other things first.’
She laughs, and when Riley turns to look at me, I could swear he raises an eyebrow.

I’ve been coming to this sheltered housing block for years, but if Sheila wasn’t here to lead me to the guest room – down a long corridor, to a sharp, unexpected left through a fire door set back in a recess, out onto a tiny, overgrown patio surrounded by fences, with two doors facing each other, one to an electrical plant room, one to the guest room – I’d never have thought it was there.
‘It’s a good job we’ve got this room,’ says Sheila, talking quietly to me as we walk. ‘Alan wasn’t at all safe where he was. I don’t know if you know the story…?’
‘They didn’t tell me much.’
‘No? Well – short version – Alan was living in our sister place over the other side of town. He’s a lovely old guy, bit vulnerable, likes a drink, never been any trouble. Then a month or two back he got himself involved with this fella Chris, a nasty piece of work, a real polecat, d’you know what I mean? About twenty years younger, a really aggressive sort, who knocked him about, stole his things, used his cards and I don’t know what else. And then the police got involved but they said they couldn’t do nothing in the end because Alan wouldn’t press charges. Psychological, you see, a lot of it. And he’s such a sweet and scrappy little thing. Skin and bone – that’s it – I’ve seen more meat on a daddy long-legs. We’ve been trying to feed him up, and what have you, and he gets proper grumpy about it, but we can’t just let him starve. All this is short term till we can sort something better. But he can’t go home, not with that Chris hanging around. He knows not to show his face round here whilst I’m on duty. And if he comes when I’m out, I’ve warned the others what to say, and to call the police. And hopefully, even if he does manage to get in, no-one’ll know where to send him.’
Just before she knocks on the door she says to me: ‘And that’s why they call it the guest room, you see? Because if you didn’t know it was there, you’d never have guessed!’
She waits for me to laugh.
‘No? Oh, please yourself…’
I follow her in.

With the rail at the bottom of the stair lift extended, there’s no room to open the front door. So I stand outside watching through a window as Mrs Michaels rides down, her son Lionel behind her with one hand resting on her shoulder to keep her in place. Once the chair reaches the bottom – after such an inching, infinitesimal glide it feels less like the chair moving and more like me growing – there’s a great deal of chivvying and coaxing and psychological game-play to get her onto her feet and far enough forwards so Lionel can put the chair into reverse and re-activate the folding mechanism.
He hits the button.
The rail judders and flexes back into position.
He opens the door.
‘Sorry about that!’ he says, breathing hard. ‘Bad timing!’

I follow them into the front room.

You’d never put them as mother and son. Mrs Michaels is a tiny silver mouse of a woman, with pinched features and uncertain blue eyes; Lionel is enormous, his t-shirt riding up over his belly, his palms pointing backwards as he walks, and a friendly if rather dazed expression, like he turned to say hello and unexpectedly walked into a wall.
‘It’s been that kind of day,’ he says. ‘Everything happening at once. Not as bad as yesterday, though.’
‘Why? What happened yesterday?’
‘Well – we’d been waiting for this new fridge to be delivered. I had to pop out for an hour, but I made sure I was back for the time slot they said. When they didn’t show I rang them up. We delivered it they said. Er – no you didn’t I said. Er –yes we did. The driver got a signature and everything. So I said to them, I said Well how come I’m looking around and I can’t see no fridge? They said they couldn’t do nothing about that. They had a signature. The driver dropped it off. They’d fulfilled their side of the bargain. You’ll have to take us to court they said. Well for a start that doesn’t scare me, ‘cos of the job I used to do.’
‘What job was that?’
‘Bailiff. So anyway, I said Fine, then. See you in court. I think they were a bit taken aback by that. It’ll just be your word against ours they said. But I told them I had a secret weapon…’
He nods at the wall behind me. At first I think it’s just a normal flat-screen TV, but then I realise it’s divided into segments, each one a different view of the house, timed and dated.’
‘Smile! You’re on candid camera!’ he says, and then exhaling heavily through his nose, and tugging his t-shirt down,  and folding his massive arms across his belly, turns to look at his mum.
‘In’t that right?’ he says. ‘Candid Camera?’
But in a spooky way, although her eyes are open, and there’s a suggestion of a smile on her face, I think Mrs Michaels is actually asleep.

Mrs Hornchurch had an episode of fast AF last week, was rushed to hospital by ambulance, cardioverted in resus, kept in a couple of days and discharged home yesterday. She has a blown, slightly startled look to her, and holds a handkerchief in her hands, turning it over and over.
She’s taken me through to her front room. It’s as hot as an orchid house in there, with the sun blazing through the patio windows, the radiators on.
‘This is a nice spot,’ I say, immediately sweating.
‘I like it toasty,’ she says.
Just the other side of the glass is a timber walkway leading down to the garden, and a small, black café-style table with a single chair.
‘My great grand nephew Josh built that,’ she says. ‘He’s a carpenter.’
‘Looks like he did a good job.’
‘He did a very good job. He’s a very good boy. He did it when he came back from Thailand. He came straight over from the airport and hardly stopped for tea.’
‘It must make it easier getting down to the garden.’
‘It wasn’t for me. He built it for Ralph, when his hips started going off.’
‘Ralph?’
‘My lovely dog.’ She nods over to a framed portrait on the wall, a Border Collie. ‘He died last month.’
‘I’m sorry to hear that.’
I clip the SATS probe on her finger and count her pulse at the wrist.
‘Collies – I think they’re the most intelligent breed,’ I say. ‘I mean, we’ve got a lurcher, Lola, and she’s pretty fast, although she’s slowing down a bit now. And you know, the only thing that’s ever been able to catch her is a Collie.’
‘Really?’
‘Yep. What he’d do, this Collie, he’d sit down and watch her go racing off in the distance. And he’d take his time, figuring out all the angles. Then he’d stroll over to cut her off at the nearest point. And she’d pull up short, you know. She’d dig her paws in, like one of those cartoon stops. And she’d look up at me in disgust. What am I supposed to do with this?’
‘They are smart,’ says Mrs Hornchurch. ‘Poor old Ralphie.’
I unclip the probe, write the figures down, and wrap the blood pressure cuff round her arm.
‘The only thing that uses the ramp these days are next door’s cats,’ she says.
‘How many cats?’
‘Four or five. I think it’s four. I think one of them just goes round again. It’s like they take it in turns, up and down, up and down, tails in the air, like models on er…on a catwalk.’
‘And what do you think about that?’
‘I don’t mind. I’ve never been one of those I’m a dog person or I’m a cat person. I’m just an animal person. They’re all different, aren’t they? They’ve all got their thing. I even like watching birds on the bird table.’
‘I bet the cats, do, too.’
‘Oh – they’re interested all right, but they never seem to do much about it. There’s this one bird, a wood pigeon. A big old item. I’m surprised the table’s still upright. He comes down and he just sits there, and he eats and eats and eats. Clears the whole table. I call him Henry.’
‘The Eighth?’
‘No. The Hoover.’