In a rare coincidence, three separate teams have arrived at Lily’s house at the same time: carers, occupational therapists and me, the assistant practitioner. It’s a small house, barely room for Lily, her husband Denis and her son, John, let alone five other people, each with their bags of equipment. The OTs have even got a bed-rail to be fitted.
‘Who else is coming? The army?’
‘Yep. But don’t worry. They’re lowering themselves down from a helicopter.’
‘Oh. I see.’
Lily lives right on the western fringe of our area. I’m guessing that everyone’s made the same calculation: do the furthest one first. Consequently, none of us is in a position to say I’ll come back later. We’re all on a tight schedule. It’s now or never.
We work round each other. It’s like one of those puzzles where you have to think three moves in advance of the move you want for yourself. We stash bags strategically, move furniture, hand each other things if we happen to be near them, the whole thing like an improvised game of Twister. Lily’s husband has dementia. He gets moved from seat to seat (along with the seat), each time landing placidly and looking over the whole mess with a wintery blue vacancy.
‘Are you going to be long?’ says the son, John. ‘Only I’ve got things to do.’
Despite our reassurances, Lily is getting more distressed. She hasn’t long been out of hospital. Getting discharged must have been a huge relief, but now it must seem as if the hospital has simply followed her home.
‘Now – I just need to do a quick ECG,’ I tell her. ‘Could we clear the room for a moment whilst I stick on the dots?’
Everyone but Denis finds a route out. He sits on his seat, watching, his stick  planted in front of him.
‘And the last dot goes round…here. Thank you. Now then. Let’s see how it’s looking.’
‘Wobbly,’ she says, and glancing over at Denis, she takes a deep, sad breath.

*

That first appointment sets the tenor of the day. I race around town, fighting to cover all my appointments, struggling to get my head round the complexities of each case, the social aspects, medication regimes, observations and their significance, writing up my notes, figuring out what each patient needs.
Back at the hospital, it’s obvious everyone’s had a similar day. We’re coming in like bees to a hive, doing our little dances, handing over intelligence.
The co-ordinator for our team looks unhappy. He doesn’t meet my eye when I go through my patients. The stress of his position inevitably means he has to strip each patient down to the bare facts: NEWS score (the higher the score, the sicker the patient); whether you did what you were down to do; can they be discharged?
‘The ECG didn’t show anything new. AF, that’s it.’
‘Did you take the ECG to the surgery?’
‘No. There wasn’t anything acute.’
‘You’re supposed to take ECGs to the surgery.’
‘Well. Okay. I didn’t know that.’
‘No-one told you?’
‘No.’
He shakes his head. Jabs a note onto the database.
‘If there had been acute changes I would’ve taken it round,’ I say.
‘That doesn’t matter,’ he says, leaning back in his chair, still not looking at me. ‘You’re not a doctor. You’re not supposed to interpret these things. If Lily dies it’ll be your fault.’
‘Fine!’ I say, flaring. ‘Put me down for Lily’s death. And if you have a heart attack going home tonight, put me down for that, too, because maybe I was the last one to talk to you.’
‘It’s a responsibility,’ he says. ‘You’re supposed to take ECGs to the doctor. That’s it.’
‘So what am I? Just someone who carries stuff around?’
He shrugs.
‘If something happens…’

I finish handing over my patients, glacially polite.
Gather my papers together and go to the folders cabinet to file them away.
Ellen the pharmacist comes over and asks if I want a cup of tea.
‘That would be absolutely wonderful.’
‘How do you take it?’ she says, then smiles warmly. ‘The tea, I mean.’

On top of everything else, Jenna’s mum has picked up a C. Diff infection. The subsequent diarrhoea has made her condition even more difficult to treat. As a service we’ve been sending in two people at a time, four times a day, as well as providing a hospital bed, commode, zimmer frame, washing equipment, sanitary supplies. Even with all this help Jenna is only just about coping. It’s horribly stressful for her. I can tell from the pale, taut expression on her face she’s coming to the end of what she can bear.
I’ve been sent round this morning to check on how things are going. It coincides with another liberal bowel movement, and as I’m on my own, Jenna helps me clean her mother up, change her pads, the sheets and things, and make her comfortable again.
They have a dog, Rufus, a solid, brindle-coloured Staffie. He always comes to the door with Jenna, gives me a stare then a grudging little sniff and nod of the head – as much like a doorman at a fancy hotel as any dog could be without a braided jacket and cap – then turns and leads us both into the front room where Jenna’s mum is living these days.
We’re half-way through cleaning her up, fistfuls of wipes, a bowl of soapy water, towels and pads, struggling to keep the whole dreadful mess in some kind of order, when Jenna laughs and tells me to look. I turn round and see Rufus, lying on his back on the sofa, all four legs sticking straight up in the air.
‘He thinks he’s next,’ she says.

‘Sixty-six years we were married. That’s him up there, in his uniform. I didn’t know him then. I only knew him after, when it was all over. I was working in the post office. His mum used to come in all the time. She said I ought to meet her son, James. I didn’t say anything one way or the other. But then one day when I finished work he was out there, leaning on the railings, smoking, looking handsome. And he said did I want to go out Saturday, and I said why not. You never think, do you? And now look! Children, grand children, great grand children. See that one, there? New Zealand! Jimmy never used to talk about the war, until later. Something stuck in my mind, though. He said there was a wreck once, and there were people, drowned, floating upside down, so all they could see were their feet. Do you think that’s possible? How would you even see their feet, in the waves? It upset him, though. Upset me, too. But it’s not the kind of thing you think about, is it? Poor drowned people, upside down, in the waves?’

Colin’s blood pressure is so high I almost have to nip his arm in two before the systolic reading ebbs away.
‘For chrissakes can’t you stop? You’re killing me!’
‘Sorry, Colin. There – all done. I’m afraid it’s pretty high.’
‘I told you it would be. It always is when they do it.’
‘When was the last time?’
‘The last time what?’
‘The last time they did your blood pressure.’
‘Well – the last time they was here, of course. Sylvie – you tell him what he wants to know. I can’t make head nor tail of it.’
He looks over at his daughter, Sylvie, who is sitting over by the window, rubbing her hands anxiously, smiling the kind of smile you might hold in front of your mouth on a stick.
‘Dad doesn’t like having his blood pressure done,’ she says. ‘It always goes high.’
‘Two hundred and twenty over a hundred and five is pretty high. If it went untreated you’d be at risk of stroke.’
‘I don’t want that,’ says Colin. ‘Just give me a ticket to Switzerland, that’s all I want. I don’t want to be no bother to no-one. You got to know when your time’s up.’
‘I’m sorry you’re feeling like that. Have you been taking your blood pressure medication?’
‘Me? No!’
‘Why not?’
‘It’s not doing me any good, that’s why not. They put you on all these tablets. Half the time they don’t know what they do. And then they just expect you to keep taking ‘em without another word for the rest of your life. Well I’d had enough of it. So I decided not to bother no more.’
‘How long ago was that?’
‘About a month.’
‘I think that’s probably why your blood pressure’s crept up, then. I think you should go back on the meds and then speak to your doctor about your prescription. There are lots of different types. If you don’t think this one’s right, there are plenty more.’
‘But you can’t tell me?’
‘I could tell you roughly, but your doctor’s the expert. They’re the ones in charge of your medication.’
‘But not you?’
‘I’m not a doctor.’
‘No. You’re not, are you?’
He shifts in his chair, flinching and muttering. When the pain of that position change eases, he starts on again, jabbing his finger in the space between us like he’s trying to shake something off.
‘Well maybe you could explain this to me, then,’ he says. ‘Years ago, we never had all this. You never used to get all these people sitting about the place taking handfuls of pills. It was all fresh air and decent food, and a job of work to do. Not all this…’
He gestures to the room, the zimmer frame and commode, the bed strewn with tissues and wipes, remote controls and magazines.
‘… all this fuss’ he says at last, helplessly. ‘I mean, what happened to all them people?’
‘They died,’ says Sylvie. She looks utterly forlorn for a second or two, but then finds the smile and holds it up again. ‘You’ve got to take your meds, Dad,’ she says. ‘You never told me.’
‘What are you writing?’ says Colin, ignoring her.
‘I’m just putting down a few things in your notes. Your blood pressure, pulse and what have you. The fact you stopped taking your blood pressure pills.’
‘Fact? Wha’d’ya mean, fact? I never said I stopped taking them. I just said they weren’t agreeing with me, that’s all. Don’t you go getting the wrong end of the stick, writing a load of lies and getting me into trouble.’
‘It’s not a question of getting you into trouble, Colin. We’ve just got to figure out the best way to help you. If you don’t want to take your meds, you don’t have to. It’s a free country.’
‘I tell you another free country,’ he says, folding his arms.
‘Where’s that?’
‘Switzerland.’

With his basin haircut curling under his ears, Edward wouldn’t look out of place in a stained glass window – the Patron Saint of Neglect. He hasn’t shaved in a while, but his beard is still only a few wispy sprouts;  he seems to have paid more attention to his eyebrows, though, plucked into delicate arches, giving his slack face the expression of a man used to disappointment. His flat is filled with porcelain fairies, plastic orchids in brass urns, alabaster cherubs, prints of Victorian scenes – everything covered in a thick layer of dirt, half dust, half nicotine.
‘Would you mind not smoking, Edward?’
He grunts, but pinches off the end of his cigarette.
‘Thanks very much. I won’t be long. So – how are you feeling today?’
‘Bloody awful,’ he says.
‘Oh? I’m sorry. In what way awful?’
‘Me feet, me legs. Me back don’t half hurt. I’ve got pains in me sides, here and here. I’ve got these shooting sensations into me chest. I can’t eat. I can’t sleep. My head’s all woozy and stuffed up. Apart from that, I’m fine.’
He gives another little grunt, jerking back a little and resting his eyes on me just long enough to check that I got the joke.
‘Well I tell you what, Edward.  How about I run through a set of obs, and then we’ll have more of a chat about what’s going on? How does that sound?’
‘You do what you like,’ he says, and rolls up the arm of his dressing gown. ‘You people generally do.’ Amongst the blurry old tattoos, the outline of multiple ECG dots on his skin.
‘The intercom don’t work,’ he says. ‘When the council come to put a new door on they cut through the cable. My phone don’t work, neither. That was nine months ago.’
‘Nine months? Have you told them about it?’
‘They don’t want to know. They give me this number to ring. BT or someone. But I said to them: How am I going to ring BT if I haven’t got a phone? They didn’t have an answer to that. Well, Gerald, this so-called friend of mine, he came round and he said why don’t I lend you my phone and you can call them on that? So I dialled the number, and I explained the situation. And they said it’d cost a hundred pounds to get it re-connected. How am I supposed to get hold of a hundred pounds? I said. You might as well say a million. So then Gerald, this so-called friend of mine, he said he’d lend me the money to get a mobile phone from Tesco. They only cost a tenner he said. You could have it on you all the time. But I said to him, I said How am I going to get to Tesco? Well, he said he’d take me on the bus, but I said with these legs? What was he trying to do – kill me? So then he said he’d go over and get it for me. So he did. But when he come back, I didn’t have nowhere to put it, and anyway, the buttons were too small, and I kept losing it down the sofa. Gerald, this so-called friend, he ended up buying another one, but then it turns out you’ve got to keep it charged up, and I’m not made of money. Not that anyone calls,’ he sniffs. ‘Specially not Gerald.’

‘The doctors don’t know what’s wrong with me and they don’t care.’
‘I’m sure they do care, Marjorie. It’s just they’re really busy. Not trying to make excuses or anything.’
‘The carers are the same. They come in, they go out. Sixteen minutes and that’s your lot. No-one wants to sit down and talk. And even when they do, they don’t want to listen.’
‘It’s difficult, isn’t it? When they have so many patients to see. No-one likes it. It’s symptomatic of a system under strain.’
‘Could you pass me that cardigan? Not that one, the other one.’
I drape it round her shoulders. She shrugs it on a little closer, her face slack with a depression as irresistible as gravity.
‘Do you have any family in town, Marjorie?’
‘There’s just one son left to me now. The one who never liked children. He’s an accountant. He chose that path in life. He doesn’t know what to do with me.’
‘I’m sure it must be hard on everyone.’
‘I had a daughter, but she died.’
‘I’m sorry. What did she die of?’
‘Cancer. Of the brain. She went to the doctor with these headaches. Sinusitis the doctor said. By the time they scanned her the tumour was as big as an egg. Dead in a month.’
‘That’s awful.’
‘And now this. I used to go down the day centre, but now I just sit indoors all day. I made some friends but they’re all gone. I’ve had every test you can think of. I’ve had cameras up me. They’ve taken no end of blood. Opened me up and rummaged around like a suitcase at a jumble sale. Looked at my heart. You name it they’ve done it. And they still can’t make up their minds. They put me on these water tablets but they haven’t done any good. I’m swelling up like a balloon.’
‘I think sometimes it’s difficult to figure out what’s going on. It’s not always straightforward. The next appointment might be the one that makes the breakthrough.’
She snorts, and grinds me into the carpet with her eyes.
‘You think?’

Wendy’s house is filled with the faces she’s painted over the years, portraits of old men, young girls, mothers and their babies, soldiers and their rifles, businessmen, socialites, farmers, priests – a fascinating array of characters from Wendy’s long life and travels. The hard fact is that now, the artist barely recognises herself.
‘Who sent you?’
‘The doctor.’
‘Why on earth would they do that?’
‘I think they want to make sure you’re okay.’
‘Of course I’m okay. I’ve never heard such nonsense.’
‘Is there anything I can help you with this morning?’
‘Such as?’
‘Well I don’t know. What do you feel like? Would you like to have a wash and get dressed?’
Wendy’s still in her dressing gown. It’s been a while since she was in anything else.
She glances at her friend Pamela, sitting next to her on the sofa.
‘What is this all about?’ she says. ‘Who is this man?’
‘It’s Jim. From the hospital. He’s come to help you with things.’
‘Help me with things? How ridiculous! I don’t need help.’
The trouble is, she really does. And if the jury’s still out on the cause of her acute onset dementia, there’s no doubt about the effect. Everyone’s rallying to the cause – her family, neighbours, health and social services. People have been remarkably kind, sitting with her, holding keys, doing what they can to keep Wendy going. But her confusion is reaching a point now where the basics of living are becoming impossible to maintain, and there are growing concerns for her safety. And Wendy sits in the middle of it all, a bewildered figure in a red silk, poppy-patterned dressing gown, one hand folded in the other, looking around with preternaturally blue eyes.
‘Who sent you?’ she says.

Walter became unwell and fell over earlier in the week, and the doctors still haven’t been able to find out why. Walter’s in his late eighties, but despite the depredations of old age and this recent bout of ill health, he’s managing to stay pretty stoical. A scientist all his life, his curiosity is bracing.
‘Neutrinos!’ he says, unexpectedly, as I prepare the kit to take some blood. ‘Do you know what a neutrino is?’
‘Absolutely no idea. Isn’t that what they’ve been chasing round the Hadron Collider?’
‘In a way, yes. Of course it’s most famous for the Higgs-Boson, but it’s exploring and testing particle physics generally.’
‘Sharp scratch…’
‘And what is the purpose of this blood test, you say?’
‘It’s a general screen to find out if you’re having any problems with renal or liver function, if you’ve got an infection, that sort of thing.’
‘I see.’
‘You know this Hadron collider?’ I say, drawing off the blood.
‘Yes.’
‘Didn’t it suffer some catastrophic failure because a bird dropped some baguette in it?’
‘It’s had a few technical problems. I don’t know so much about the bird. But you see, a machine of that size and complexity is quite a proposition.’
‘I bet.’
‘It’s many miles long. Through a mountain.’
‘So you wonder how the bird got close. I mean, don’t they have covers on the vents?’
‘I’m sure they do. The point is, it’s already pushing the boundaries of what we know physically about the world. The very essence of being.’
‘Well – here’s some of your essence.’
I hold up the two phials of blood.
‘Thank you. It will be interesting to see what changes there have been, if any.’
I put them into the pathology envelope and seal it.
‘Did you ever meet anyone famous?’ I ask him, packing away. ‘Did you ever meet Einstein?’
‘Einstein? No. But I did meet Heisenberg. Have you heard of him?’
I want to say ‘Breaking Bad’, but don’t.
‘He was most famous for the Uncertainty Principle.’
‘What’s that?’
‘Basically he postulated that it’s impossible to know both the position and momentum of a particle with any precision. He wasn’t like Newton, you see, who thought that once you knew all the facts the universe would reveal itself to you like some gigantic mechanical clock. It’s much woollier than that. And more interesting.’
‘So what was he like?’
‘Who?’
‘Heisenberg?’
Walter rolls down his sleeve and shrugs.
‘Fat,’ he says. ‘Very fat.’

The Scheme Manager’s worried about Harry.
‘He’s always ploughed his own furrow, if you know what I mean,’ he says. ‘He’s got his ways. He lost another carer last week because of his behaviour. Saying inappropriate things. But I’m not sure if that isn’t a symptom of something else. I mean, the other day he came into the office and asked me to call him an ambulance, and when I asked why he said it was because he’d swallowed his teeth and wanted an x-ray before he ate himself up from the inside. And then of course he put the kettle on the stove and melted it. The doctor gave him some antibiotics for a water works infection, and I know that can make you go a bit funny. But anyway, see what you think. He’s up in his room.’

Harry is sitting in a threadbare armchair watching TV. To his right is a bed and a bedside table. Apart from that, the room is completely bare. No pictures on the walls, no ornaments on bookshelves. No bookshelves. It’s more like a cell, a machine for living:  the TV for entertainment, the kitchen for eating, the bed for sleeping.
‘All roight?’ he says, nodding as I come in. ‘Now I wonder what you’re after?’
He has a rich Fen accent, strangely flattened O’s and sudden upward inflections. I try to think of some way of making him say toast or ghost.
 ‘I s’poos it was the ol’ doctor sent fer ya?’ he says.
‘She wants us to keep an eye on you the next few days. Just to make sure the antibiotics are working.’
‘Oh thar workin’ all roight. Oim already feelin’ a bit more of a spring in me tail!’
He holds his right arm up at the elbow, fist clenched, and gives it a lascivious wiggle.
I don’t doubt the carers had their hands full.
I unpack my stuff and start the examination.
‘But they’ve already done all this,’ he says, rolling up his sleeve. ‘They can’t foind nutthin’ wrong. Oil bet oim fitter’n what you are, mate.’
He’s not wrong. For someone in his late eighties, he has a fine set of obs.
I pack all the gear away again and chat whilst I write my notes.
‘So where are you from originally, Harry? The Fens?’
‘Tha’s it! How’d’you noo that, then?’
‘Wild guess. What work did you do?’
‘You name it. I could put moi hand to moost things. Buildin’, labourin’, pickin’. Oi was what you moight call handy!’
‘And what about now? Do you have any family in town?’
He suddenly looks serious and points up at the ceiling.
‘Only moy woif,’ he says.
For a second I think he means she lives upstairs, but then I realise she died.
‘I’m so sorry,’ I say.
‘Oim not,’ he says, brightening up again and folding his arms. ‘She ran orf with Stooart, ‘er fancy man. But when she doid oi ad ‘er cremated all proper, loik. Waa’ll, she was the woif, ar’ter all. Apart frem thet, oi wurnt thet baa’therd.’

I knock and let myself in.
Hello? It’s Jim, from Rapid Response.
A short, narrow corridor. Five doors – one at the end, four to the right. I start at the end.
Hello?
An airing cupboard.
Hello?
Bathroom.  And then working backwards, via the sitting room, kitchen – until the last door, which I notice for the first time has a crooked sign on the handle: William’s room.
I knock and go in.
Hello?
William is lying on a pile of three mattresses, none of them covered, all of them dirty. It makes me think of the Princess & the Pea, a grim re-working, with a schizophrenic princess not coping at home, and not a pea but a box of psych meds under the bottom mattress.
Hello, William. How are you doing?
It’s hard to understand him when he answers. He gabbles excitedly, and his wild beard obscures his mouth. He obviously knows I’ll struggle to understand, because without being asked he immediately repeats himself – and keeps repeating it, on a loop, until I get the gist.
‘You’ve been chastised? What do you mean, chastised? Have you been assaulted?’
He tries to explain but I can’t understand.
I know from his notes he had a fall because of a urinary tract infection, and we’ve been asked to go in and support him whilst he gets back on his feet. His yellow folder is a beacon of cleanliness in the room and I go to it for guidance whilst William arranges himself more comfortably on the bed.
‘I want Shreddies and Yazoo,’ he says, over and over till I understand. ‘Keep them separate.’
I go into the kitchen, wash a bowl up, put some dry Shreddies in there, and then open the fridge for the milk. Inside the fridge are ten packets of processed cheese slices, a loaf of bread, a couple of tubs of butter spread and half a dozen bottles of Yazoo flavoured milk.
I take his breakfast through to him.
‘Thanks. Thanks,’ he says, and ignoring the spoon, starts to finger-up the Shreddies.
I clean up a little, try to put the meds in some kind of order, and make some notes.

*

I go back for a tea-time call.
William is dressed but still lying on the mattresses.
‘Can I fix you something to eat, William?’
He pushes himself into a sitting position.
After a while I understand what he wants. ‘Four slices of buttered bread, Yazoo cheese, and a Coke.’
‘Yazoo cheese? I didn’t know Yazoo made cheese?’
‘Four slices of buttered bread, Yazoo cheese, and a coke.’
‘Okay then.’
‘And count how many Cokes are left.’
In the kitchen I make space enough to prepare the food. I look through the fridge for the Yazoo cheese, but all I can find are packs of processed cheddar slices. ‘He must mean those,’ I think, taking a pack out.
I clean a plate and knife, and prepare the food. I take a can of Coke from the Cash & Carry size tray on the side, and go back into the bedroom.
When I hand the food to William he pokes at the cheese and looks distressed.
‘Yazoo cheese!’ he says, over and over.
‘There isn’t any Yazoo cheese, though.’
‘Yazoo cheese!’
I take the cheese back into the kitchen and have another look. Right at the bottom of everything is one pack of Edam slices. I take that through.
‘Is that what you mean?’
His eyes widen and he reaches out.
‘How many Cokes?’ he says, pawing at the pack.
‘Thirty-eight, not including that one.’
He nods enthusiastically, and starts to eat.