‘You have lovely arms,’ says Agnetha.
‘It’s this flattering light’
To be honest, there’s hardly any light at all. Agnetha likes to keep it low in the living room (aptly named – being the only room she lives in these days). It’s cluttered in here. A little claustrophobic. I feel like Howard Carter, surrounded by artefacts, paintings and sculptures chaotically piled up. Except Tutankhamen probably didn’t have a blister pack of meds and a commode, and Tutankhamen didn’t suddenly reach out and grab him round the arm.
‘Yes! Very well made’ she says, giving it a squeeze. ‘Not like mine. But then I’ve always been a scrawny thing. Even when I was a child. Didn’t matter what I ate, I still looked like a sparrow.’
She lies back in her recliner and closes her eyes.
Outside, two men shout and swear at each other. She doesn’t react. The house has stood in this street two hundred years. Plenty of voices have passed in that time. Agnetha is so old she must have heard half of them.
‘What did you do for a living, before you retired?’ I ask her.
‘Nothing!’ she says. ‘My mother didn’t want me to work.’
‘So how did you fill your time?’
‘I studied.’
‘What did you study?’
‘Everything!’ she says, opening her eyes wide again. ‘Everything you could think of! We had a library. I spent most of my time there, reading, reading…. oh! Any subject you’d care to name! I had a lovely childhood. Gosh – how my mother would laugh if she could see me now!’
‘Where are you from originally?’
‘Do you mean where was I born?’
‘Yes. You’ve still got a bit of an accent.’
‘Denmark. That’s where I poked my head out. But it’s like my mother always said. She said I was born on planet earth. She knew! And let me tell you something…’
She sits up and grabs my arm again.
‘You don’t need to go up in a rocket to know … we’re all in this together!’

Ollie isn’t as bad as advertised. In fact, she’s positively sprightly.
‘In here!’ she shouts when I knock on the door. We all pile in.
Far from being stuck in bed, she’s shuffling into view with her zimmer, brightly dressed in a red, roll-neck sweater, tartan trousers and smart leather shoes.
‘C’m’ere and give us a kiss!’ she says, and she cups my face in her hands when she plants one.
‘How are things?’ I say, holding her at arms’ length. It’s lovely to see you.’
‘Ooh,’ she says, and her face falls into a hooded, whispery look, as if her condition is just too much for words and she’s trying to communicate the full horror of it through her eyes.
I’ve always been struck by how much she looks like Dad. All his siblings do (or did). You’d have thought they were septuplets. The one time I saw them all together – at the eldest brother’s funeral – they could all have been the same person, give or take a few pounds, a smattering of liver spots, a wig. It’s a block-headed, graven-mouthed look, cynical, playfully disapproving. Thank God they had a sense of humour (bracing as it was), because the other thing they shared was an almost spiritual capacity for grudges, a glitteringly persistent, mineral thing that they all mined throughout their lives, to a greater or lesser extent.  For example, when John and Ollie sold their corner shop to go and live down to Devon near Bert and Elsie, there was a disagreement over shared petrol costs to some function or other. Bert and Elsie sold the house and moved on. Without telling them.
That kind of thing.
‘We brought you some cake.’
‘Ooh – I can’t have that.’ Her eyes drop down below. ‘I’ll just have a small cup of tea, though. ‘Ere – sit yourself down and tell me everything. How’s the family? Have you still got all the animals?’
‘Yep. We’re all good. We’ve just got a cat and a dog now.’
‘What about the cows?’
‘Cows?’
‘All them farm animals. Given them up, have you? Must be a lot of work.’
I can only think she means my eldest brother, who retreated down to Cornwall years ago and pulled up the drawbridge. No-one’s entirely sure what he does down there. He’s got some land. He might have a goat or two.
The girls carry on politely arranging the tea things whilst the sun superheats the conservatory.
‘Well! It’s lovely to see you!’ says Ollie. ‘What do you think about all these pills then, Doctor?’ she says, pushing a blister pack of medication my way. I’m guessing she’s thinking of Pete again, who is actually a doctor. I don’t put her right, but look over what she’s taking.
‘Not bad for ninety-five,’ I say, flipping it shut again and handing it back.
‘I don’t know,’ she says. ‘Why do they want me on all this bloomin’ stuff? It’s the dreadful pain I worry about, and none of it helps.’
She’s got a box of stronger pain meds on the side, but she doesn’t bother with them.
‘They don’t know what they’re on about,’ she says, and her cup shakes as she puts it to her lips. ‘Ah! That’s better! How long does it take to be a doctor?’
‘I’m not sure. About seven years, is it?’
‘And what if you want to be a surgeon?’
I shrug.
‘A few more years specialising. Probably ten, all told.’
‘Ten years!’ she says. ‘All that time. You never fancied it, then?’
‘No. I was too wrapped up in the cows.’
She laughs and digs me in the side.
‘That’s a good one!’ she says. ‘You and your animals!’
We have some more tea. I share out the cake.
‘Do you remember when you and John used to come down and visit us?,’ I say. ‘In that big old Zephyr Zodiac? You in your fur coat. Rusty the collie? We loved it when you turned up. With a big bag of sweets from the shop.’
‘Yu’us!’ she says. ‘I remember. All you kids in a line with your hands out.’ But then her face falls and she goes all whispery again.
‘I can’t believe they’re all gone, y’know. Every last one. What on earth happened? I can’t work it out.’
Truth was, apart from Dad dying of cancer, they all died of extreme old age, as far as I can make out. But of course I don’t tell her that. It wouldn’t help, and anyway I don’t think she means it in that way. I think she means she used to be surrounded by people, and now she’s on her own.
‘I know,’ I say. ‘It must be very hard.’
I decide to take the opportunity to ask Ollie about an old family story.
After John and Ollie got engaged (after a first date, by the sound of it), John went off to fight in Europe. Ollie heard nothing for months, until she got a telegram saying John was missing in Italy, presumed dead. Ollie came to terms with it, met a GI, they got engaged – and then John showed up again. Turns out he’d been in a POW camp, with just a tiny, crumpled photo of Ollie to keep his hope alive. Escaped from the camp and fought with the partisans. Finally made it home. The GI was so distraught, he stood on Westminster Bridge and threatened to throw himself in the Thames. The rest was history, though – family history, the most unreliable type, it would seem.
‘GI?’ says Ollie. ‘What GI? What’re talking about? I got the telegram all right but I knew he weren’t dead.’
‘Really?’
‘No. He was writing letters to Bert all that time. He never wrote to me, though. Why d’you think he never wrote to me?’
‘I don’t know,’ I say, helplessly. ‘I can’t think.’
‘I know why,’ she says. ‘He took up with an Italian girl. I think they got married.’
‘But – wasn’t he in a prisoner of war camp?’
‘He was. And he escaped, and that’s when he hurt his back. They caught him and put him back in prison. But then he did it again, and this time he stayed out. He went to this Italian farmer who had five girls. Five! Well – you can imagine John, can’t you? Standing at the foot of the ladder. Can you just fetch me down them peaches? And the girl going up the ladder. With no knickers on. He had the pick of the bunch. And I think he married one. But Bert wouldn’t let me see any of the letters, so I never did know.’
‘Blimey! Then what happened?’
‘Then he shows up. No boots, just a couple of quid in his pocket. And we started from there.’
She leans forward and rests her hand on my arm.
‘Forty-seven years we were married,’ she says, darkly.
‘I think it was longer than that, Ollie…’
‘Forty-seven. And we never spoke another word about it.’
We have some more tea.
‘’Ere. Let me show you my painting,’ says Ollie, reaching behind her and pulling out an A3 sketchbook. ‘Wha’ d’you think?’
It’s impressive that at ninety-five she’s taking up a new hobby. Landscapes. Seascapes. Views of the garden. They’re not too bad.
‘Wow!’ I say. ‘When’s your exhibition?’
‘Exhibition!’ she says, digging me in the ribs again. ‘Look. Wha’d’you think of him?’
She flips the pages and shows me a portrait of a collie dog.
And the thing that strikes me most is his expression – blockish head, hooded eyes, disappointed, downward cut of the mouth.
‘He’s lovely!’ I tell her.
And side by side, we stare at him a little longer.
‘Whose dog is that, then?’ I ask her.
‘Oh – I don’t know,’ she sighs, flipping it shut. ‘It’s just some photograph.’

John holds out his hands.
‘I’m losing them,’ he says, turning them this way and that. ‘It’s hell. I can’t play the guitar n’more. And I can’t fish.’
He nods over to a stack of rods in the corner of the room.
‘Where did you used to go?’
‘Off the beach, until I couldn’t keep my balance on the pebbles when they shifted.’ He folds his arms and settles back on the bed. ‘Then it was just concrete places, you know. Jetty walls, outfalls. Listen – are you going to be long?’
‘Nope. Almost done. Just got to write a couple more things on the ticket and I’ll be off.’
‘Good,’ he says. ‘I’m just off myself. Down the shops. For some food. And fresh air.’
I sign the form and tear off a copy.
‘Did you ever fish off the marina?’ I say, putting the form with the other papers on the table.
‘Used to, until they changed the management and went all Health and Safety. “Oh – it looks like rain. I think you’d best not go out there today” or “Oh – I don’t like the look of that swell. Make sure you keep away from the edge.” Keep away from the edge! We used to clip ourselves to the railings in the big storms so we didn’t get swept over. But it was worth it. Man alive! One twenty pound cod n’ you’d be made!’

Mr Dexter comes out into the hallway, carefully putting his door on the latch first.
‘I’m the only sane one left in the block,’ he says. ‘I’m not kidding. Every single other flat – one on top of the other. I don’t know how much more I can take.’
‘I’m sorry to have bothered you.’
‘It’s no bother. I’m only saying.’
‘I just wondered if you might know anything. I’ve tried knocking. No answer. Shouted through the letterbox. Nothing. I rang his phone, got the same.’
‘He’s not in, then.’
‘I bet. It’s just – with his history…I wanted to be sure.’
‘The dog didn’t bark, did it?’
‘The dog?’
‘He’s got a dog, you know. Did it bark?’
‘No.’
‘Well they’ve both gone out, I ‘spect. The dog normally barks when someone comes to the door.’
‘Oh.’
‘It’s all getting too much. Do you know – the other day – I had to have the police out. He was collapsed just there, in the corner. Wouldn’t get up. I said you can’t stay there like that, mate, and he said why not. But he didn’t look all that clever. So I got the police out.’
‘Not the ambulance?’
‘No. I asked him was he sick and he said he wasn’t, he was just tired.’
‘What did he say when the police got here?’
‘Not much. Just very – you know. Vague. They put him back in his flat and made a report or something, I don’t know.’
‘Maybe that’s where we come in?’
‘Maybe it is. Something’s gotta happen, because it’s all getting a bit much.’
‘Sorry.’
‘It’s not your fault. It’s not his, either.’
‘No.’
‘Or the dog’s, come to that. What are you going to do now?’
‘I’ll probably come back later.’
‘And what if he doesn’t answer then?’
‘I don’t know. Kick the door in?’
Mr Baxter laughs.
‘They did that last week,’ he says.
‘And were they in?’
‘Yep.’
‘So the dog didn’t bark then?’
‘No. They were both asleep.’
‘Asleep?’
‘Well. He walks it a lot. Probably wore him out.’

Leonard reminds me of that story by H. G. Wells, The Truth About Pyecraft. About a large man who uses an occult recipe for weight loss, and ends up floating around the room. Because the only thing that’s stopping Leonard bouncing up against the ceiling is the chair. He fills it completely, dangerously, like a spacehopper that’s been hyper-inflated between the arms of it, and would need a little air letting out before you could grab its ear handles and pull it free. He has a similar expression, too – a fixed grin that could be humour or distress, it serves the same purpose. The only difference is Leonard’s beard, a full and grey goatee that marks the end of his face and the beginning of his neck, and catches soup and crumbs and jam when he eats.
‘How are you doing today, Leonard?’
‘How am I doing? Terrible!’ he wheezes. ‘When are you lot going to stop coming round, asking all these questions?’
‘I don’t know, Leonard. You’re not well at the minute. People are worried.’
‘What people?’
‘You know. Your doctor, for one.’
‘That’s not people.’
‘Anyway. You don’t have to have us round. You can always say no.’
He sighs, and grasping the arms of the chair, waggles his legs to work himself into a better position.
‘Oh, well. Seeing as you’re here…’ he says.
I unpack my kit.
Leonard has an elderly cat, Buttons. Buttons is a beautiful, frail tabby, with a super-steady gaze that’s quite unnerving.
‘Hey Buttons!’ I say, holding out my hand for him to sniff. He doesn’t drop his eyes from mine. I lower my hand again. He turns his attention to Leonard.
‘Oh God!’ says Leonard. ‘Not you again!’
Buttons gives himself a rickety wind-up, then leaps onto Leonard’s lap; after a second or two, he plants his paws in the centre of Leonard’s chest, and then doubles his body length to look right in Leonard’s face, nose to nose.
‘Oh God!’ says Leonard.
Buttons starts licking the old food from Leonard’s beard. It’s such an appalling sight it stops me in my tracks. But then I come to the rescue, and pick Buttons off his chest, unhooking his claws when he digs them into Leonard’s t-shirt.
I set him down on the floor again.
‘Damn cat!’ says Leonard.
‘How long have you had him?’
‘I don’t know. He wandered in one day and I haven’t been able to get rid of him.’
Buttons stares at me as I go to take Leonard’s blood pressure.
‘It’ll be high,’ says Leonard.
He’s right. Spacehopper high.

It was a stressful start.
The team meeting had quickly deteriorated into a bitter ‘team dressing down’. The senior clinicians had closed the service the day before, and the manager was trying to figure out why. The figures were tight but they’d been tighter. We had good levels of staffing. She was furious. What made it worse was the way she expressed her fury – more a kind of intense disappointment. She had faith in us and we’d let her down. She’d gone away on a training course because she’d been confident we’d be able to cope. We hadn’t even phoned her before making the decision to escalate and close the service to new referrals.
We hadn’t even phoned.
On top of that, the workload was as brisk as ever. I had six patients to see, a couple of them known to be complex, all of them spread around town. The meeting had made everyone late. I knew it’d be a struggle to get round in time. I did what I could to prepare, and hurried out to the car.
I thought I’d tackle the most difficult case first – Jeremy, a vulnerable elderly man new to the area who’d stopped taking his meds and was being worryingly uncooperative. He’d thrown one of the nurses out yesterday, and I was tasked to go in with as much tact as possible and find out what was going on.
I knew the block, so that was one advantage. I went straight there avoiding the traffic and parked up in the little parking area round the back. Jeremy didn’t answer his buzzer, so I phoned instead. He shouted at me when I said who I was but didn’t hang up. Just as I was finding some angle to try to persuade him to let me in, the scheme manager opened the door.
‘Have you come to see Jeremy?’ he said.
I was relieved. I told Jeremy not to worry, and if it was all right with him I’d come up and say hello. Then I picked up my bags and went in to the lobby.
‘Where’ve you parked?’ said the scheme manager, pleasantly.
‘Just round the back,’ I said.
‘You’ll be clamped.’

It was such an abrupt change in the tone of the conversation I laughed. I thought he was joking.
‘I’m serious,’ he said. ‘You’ll be clamped and fined.’
‘But – I’ve got a permit.’
‘Won’t work.’
‘I’m a health visitor. I’ve come to see a patient.’
He shook his head.

Stress is a cumulative thing. It builds and builds and then something happens, big or small, and the switch is thrown and it all comes out.
If you’d asked me, when I was standing outside the building in the freezing wind, listening to Jeremy shout at me down the phone, thinking about the team meeting that morning, thinking about all the cases I had to see that day and how on earth I was going to fit them all in – if you’d asked me at that specific moment how I was feeling, I would’ve answered, quite honestly, fine. A little wired, maybe. Pumped-up, ready to go. Okay. And suddenly here I was standing in the lobby of a housing block, shaking.
That’s the nature of stress, though. It takes everyone by surprise, not least you.

I dropped my bag.
The scheme manager took a step back.
‘I’m a nurse!’ I said (I’m not, but it sounded shorter and punchier than assistant practitioner). ‘I’ve come to treat a patient. And you’re telling me I’m going to be clamped and fined.’
‘It’s a new thing’ he said.
‘Well – great! Lovely! Let them clamp me! And if they do I’ll quit. And I’ll leave the country. Then maybe you can take over and see to the patients.’
‘I’m just saying…’
‘Just saying! For God’s sake! What are you like? Seriously? Go on! Go and call the clampers! Lock me up! But before you do, I don’t suppose you’ll mind if I go up and look after my patient? No? Thank you very much.’
I headed for the stairs. Before the door closed behind me I heard him say ‘I’ve got a permit in the office if you’d like it…’

*

Turns out, Jeremy wasn’t aggressive so much as deaf with an abrasive manner. His meds were deranged, as was the flat. There were practical things to be done. I took blood, reassured Jeremy that nothing would be done he didn’t want to do, made plans, and left.

The manager wasn’t around in the lobby – which was a shame, because I wanted to apologise for losing my temper. It struck me that his intention had probably been just to warn me they’d changed the management of the car park, and I’d need a special permit. Parking is terrible round there and I know they must have problems. So the new regime was probably justified (although you’d think they could make allowance for vehicles with certain badges). Annoying, definitely; pedantic, perhaps, but hardly an expression of hostility towards me, or the NHS.

I threw my bag in the car and took the permit off the dashboard.
Maybe I should have another badge – one that says ‘Caution. Under stress.’
And a little tin of travel sweets, filled with Valium.

I tossed the permit onto the passenger seat along with the rest of my junk, checked the map, and hurried off to the next call.

Scene: the wake after the service at the crematorium.

Giles, a spruce ninety year old – blazer with a folded handkerchief in the top pocket, pressed slacks, polished shoes – makes his way over to a small group over by the buffet table. After some handshakes, introductions and how-are-yous, he turns to Simon, a man he hasn’t met before.

Giles:      So! I hear you’ve done very well for yourself.
Simon:         How do you mean?
Giles:    I couldn’t help but overhear. When we were all waiting in the … ah…. waiting room. How you’re almost a barrister.
Simon:         A barrister?
Giles:      Very well done. That’s quite something.
Simon:         (suddenly realising what’s happened). No, no! I managed to fix the coffee machine. I said I was almost a barista.
Giles:      Jolly good show.

I hold on to Ernie as he steps up onto the scales.
‘Just over forty kilograms’
‘What’s that in old money?’ says his wife, Nancy.
‘Six and a bit stones. Not enough for your height, Ernie.’
It’s an understatement. Ernie’s grossly malnourished, his knee joints the thickest part of his legs, the crests of his hips standing out like old crockery.
‘They’ve given him some special mousse to eat,’ says Nancy.
‘Good.’
She hooks her greasy hair back and stands over me, the seamy smell of her unwashed nightdress quite overpowering. The house has obviously never been clean, but now that Ernie’s mortally sick, at least some semblance of hygiene would help. As it is, Nancy doesn’t get the basics. When I got here it was obvious Ernie had been faecally incontinent. I set about cleaning him up, and Nancy was surprised when I asked her for a bowl of soapy water. (Soapy what?), and would’ve been quite happy for me to use the same water and flannel for his face.
The good news is they have all the equipment they need. Commode, various walking aids, a hospital bed, pressure relieving equipment and so on, much of it already tainted, but still functional, at least.

Above Ernie’s hospital bed is a set of shelves, precariously filled with dozens of toy train carriages and tangled bundles of track.
‘He used to have ‘em all laid out,’ says Nancy. ‘He’d spend hours and hours, standing in the middle of it all, watching ‘em go round.’

I help Ernie off the scales and back onto the bed. I can’t believe the change in him since I saw him a few months ago.
‘It’d be interesting to see the discharge summary,’ I tell her, thumbing through the folder again for clues.
‘They didn’t give him one. He only come out with the one bag.’
Ernie is staring straight ahead, his eyes two protuberant, glassy stones.
‘What makes his eyes go like that?’ says Nancy.
‘I don’t know. Thyroid problems?’
She snorts, and folds her arms.
‘Maybe it was the trains,’ she says.

Not counting the knock on the door or the ringing of the bell, it’s always the fifth thing I do.

The first is to introduce myself. Hello. I’m Jim, from the Rapid Response Service. Affecting a friendly but trustworthy demeanour, ready to show my ID, ready for a variety of responses, friendly to hostile, indifferent to anxious, hilarious to who the hell are you… Sometimes I’ll add a you know – the hospital, if they look nonplussed. The Hospital sounds serious and sensible, carries weight. Everyone knows what a hospital is; Rapid Response can sound like the Marines.

The second is tell them what I’ve come round for. To see how you are, check your blood pressure, temperature, that kind of thing. I’ll probably follow that up with a So – how are you feeling? as I put my bag down and orientate myself to the place, and the circumstances of the visit. Get the relatives on-side. Any pets.

The third thing is to ask if they’ve got a Yellow Folder. The Yellow Folder is the holy bible of the health visitor round here (the care folder, that other really useful book, is almost always blue). The Yellow Folder will have all the notes and obs charts, discharge summaries and clinical assessments, ambulance reports and ECGs, and most helpfully of all, the record sheets each clinician fills in when they visit. Some folders are so thick, covering so many years and conditions, you have a job to open them without everything pitching out on the floor. Others are sweetly arranged, with coloured dividers, and an index in the front. It’s quite an art handling these folders. When things are going well you can talk to the patient about their current situation whilst discreetly filter-feeding information from the various sections. When things aren’t going so well, you feel like throwing the folder out of the window and starting from scratch.

The fourth thing I’ll do is get my stuff ready. The obs kit, stethoscope, anything else I’ll need. I try to put it all out in such a way that I won’t forget it, an ‘equipment dump’, like I’ve seen the fire service run at chaotic scenes. I’ve also got a plastic folder of paperwork, the different sheets I’ll need to fill out. Who knows how many times I’ve said It’s all about the paperwork! as I lay them out in a row, like the NHS version of The Tarot.

And then the fifth thing, the main event, running the obs. I’ll start off by putting a SATS probe on one finger, and reaching for the pulse on the other wrist.
It’s a pivotal moment, when the visit turns from something almost business-like to something more deeply personal. And I’m often struck by the change.
There are lots of reasons why you should physically take a pulse. The SATS probe is just numbers, easily thrown off course by an irregular heartbeat, lurching crazily from slow to fast. Palpating the wrist and counting the beats gives you a clearer idea of the general rate, and you can also tell a lot from the quality of the pulse. But there’s something else, beyond the merely clinical. It’s a visceral thing, a basic but very human kind of contact.  It’s interesting, how such a simple action can have such a profound effect on the relationship. Even with the most difficult patient. Much more than hello, how are you or where’s the folder.
A gentle squeeze at the base of the thumb.
You can feel their heart beating.
Who’d have thought?

Michael is sitting on the sofa in front of a giant plasma screen, the sound off.
‘I’ve come round this morning to do three things,’ I tell him, putting my bag down. ‘The first is to see how you are, to do your blood pressure, temperature, that kind of thing. The second is to take a little blood if that’s okay. The third is to do an emergency shop. How does that sound?’
He nods and manages an approximate kind of smile. He’s very weak. His alcoholism has been getting the better of him lately, and long periods of vomiting and diarrhoea have left him extremely debilitated. He’s only a couple of years younger than me, but his health problems have taken their toll. He uses a zimmer frame to get about the flat, his hair is thinning and grey, and there’s a fragile, parchment-like quality to his skin.
‘My blood pressure will be low,’ he says, bunching up a sleeve. Even that exhausts him. ‘And good luck finding any blood.’
In the end it’s not too much of a problem. The left arm is hopeless, but the right has a cluster of small bruises where the others have gone in, feeding off the one good vein.
I tap and prod about, eventually driven to inspect the back of his hand.
‘Don’t worry too much,’ he says. ‘I worked in a kitchen and the chef ran me through the arm with a kebab skewer. Hit an artery and everything. That was worse.’
I use a super-fine needle. It draws okay. When the tubes are full I take off the tourniquet and stick a piece of gauze on the wound. Once the labels and the blood form are all written out, I pack everything away and get ready to go.
‘So what do you want for this emergency shop?’ I ask him, taking out a scrap of paper to write a list.
He’s distracted by the TV,  a group of animated, highly-coloured women mutely arguing on a sofa.
‘Hm?’ he says.
‘This shopping I’m doing for you. What do you need?’
He touches the gauze on the back of his hand, paddles his fingers up and down on it for a moment or two.
‘A sliced loaf and a litre of Coke,’ he says at last. ‘Diet Coke. Not Fat Coke.’
‘Is that it? No spread? Cheese, cold meats? Fruit?’ I stop before I say anything else. It wasn’t at all the list I was expecting.
‘Maybe one other thing,’ he says.
‘Okay. Go on.’
‘A bag of sugar.’