Len is panicking. He pants rather than breathes, and says oh on the outbreath. ‘I can’t….I can’t…’
‘Don’t let your breathing get ahead of you, Len. Remember what we said? You’re doing really well. You just need to slow it all down. In through the nose – and hold it a sec – then out through the mouth. That’s it.’
‘I can’t.. I can’t…’
‘Yes you can, Len. You’ve done it before. I know it’s hard but ultimately you’re the one in control. Just slow it down a touch if you can. It’ll make changing the bags so much easier.’
Len had a major bowel resection three years ago through cancer. He has two stomas – a urostomy and a colostomy. Today he needs to change the bags and stick new bases on for both. I’ve helped him shower and dry himself off. Now I do what I can to make the fiddly bag-changing process as easy as possible. I position the waste bin so he doesn’t have to reach for it, pass him the spray, the wipes, each new piece of rubber fixing, unpeeling the adhesive strips and so on.
‘Oh….oh…’
It’s difficult to watch. It feels as if any moment he’ll just give up, rip the bags off his abdomen and throw himself headlong into the bath.
‘Almost done, Len. You’re doing brilliantly.’
And finally he is done.
I help him get dressed and lead him into the sitting room.
‘I’m sorry to be a nuisance,’ he says, collapsing into an armchair.
‘You’re not a nuisance, Len. It’s a pleasure helping you out.’
‘I know you’ve got better things to be doing. But listen. If you get into trouble for being here longer than you were supposed to be, just send them my way. I’ll put them straight. I’ll tell them what you’ve done for me here.’
‘That’s very kind of you, Len.’
‘I mean it. Just send them my way.’
‘I’ll just finish the paperwork then I’ll get out of your hair.’
Len has been getting by reasonably well for the last year or so, but just lately he seems to have dropped off a coping cliff. He’ll need a new assessment of his care needs, and re-evaluation by the stoma and palliative teams.
‘The anxiety thing’s very common,’ I tell him. ‘You’d be surprised who gets panic attacks. I used to be  in the ambulance service and we came across a lot. All walks of life. I went to a police marksman once.’
‘Really?’
‘He wasn’t shooting at the time, though. He was having a rough time at home and it sort of crept up on him. He thought he was having a heart attack.’
‘I know how he feels.’
‘But the good news is it responds to treatment really well. Once you know what’s going on and sort your breathing out, all those horrible symptoms go away.’
‘You hope.’
‘And then if it keeps on happening, there are always things your doctor could prescribe to help relax you a bit.’
‘Right. Thank you.’
I look round the room. Pictures of warships on an opposite wall.
‘Were you in the Navy, Len?’
‘Twenty-five years. I worked the ferries after that. Till I retired, like.’
‘I tell you what. That’s something I could never have done.’
‘What? The ferries?’
‘The Navy. Probably the ferries too. I get sea-sick.’
‘Oh dear!’
‘I went out with a friend on his boat once. Five miles out, he anchors up and the boat starts bobbing from side to side and that was it. I wanted to jump overboard and swim back.’
‘You didn’t, did you?’
‘I wanted to. And when we did get back, I swore I’d never go to sea again.’
‘You know what the cure for seasickness is, don’t you?’
‘A bacon sandwich.’
‘Peaches.’
‘Really?’
‘Yep. Tinned peaches. In syrup. Works every time.’
‘Mind you, they say Nelson used to get seasick.’
‘Who?’
‘Nelson. You know…’ I crook-up one arm and put one hand over my eye.
‘Kiss me, Hardy.’
‘Oh. Him.’
‘Yep. Apparently he used to get seasick.’
‘Did he?’
‘Yep.’
‘Oh.’
He thinks about it for a minute.
‘Well he wouldn’t if he’d have had some tinned peaches,’ he says.

Turns out, she was there all along.
I’d been ringing the doorbell, rapping the knocker, phoning the landline – nothing. There was a keysafe on the wall by the downpipe, but no-one back in the office had the number.
‘You might have to consider calling the emergency services,’ the co-ordinator told me.
‘And kick the door down?’
‘What if she’s on the floor and can’t get up? She lives with her son, Simon, but he’s obviously not in or he’d have answered.’
‘I’ll take another look. Maybe there’ll be a window open somewhere.’
When I go back to the house, I ring the bell one last time.

The door opens.

If I didn’t know better I’d think the man had walked straight out of make-up, on the set of ‘Clown Apocalypse’. He has tufts of orange hair poking out left and right of a scurfy pate, heavy lids, a pendant line of drool, a torn t-shirt caked in spaghetti sauce and a pair of soiled trackie bottoms.
‘Oh! Hello! Is Marjorie in?’
He doesn’t respond.
‘Marjorie? Your mum?’
He sways a little. Has he fallen asleep?
From behind him, an anxious voice.
Who is it, Simon? Simon – who is it?
He steps aside, revealing a plump, pale owl of a woman, thick black rimmed glasses, mouth in an O of anxiety.
‘I didn’t think you’d ever get here,’ she says.
‘I’ve been outside for a while but no-one answered.’
‘You were supposed to be here at three,’ she says. ‘I didn’t know what to do.’
‘Sorry. But I’m here now. Shall I come in?’
Simon lets go of the door and shuffles back into the sitting room and topples back onto the sofa. The TV is blaring at top volume – Judge Grinder – camping up a judgement on a broken wardrobe and a broken family.
‘They sent a new blister pack but I don’t know what to take,’ says Marjorie, following behind me so closely I have to take a step forwards to turn round.
‘I’ll have a look for you, Marjorie.’
‘Write it all down,’ she says. ‘On this pad. In big letters, so I can read it.’
‘No worries.’
‘What?’
‘I said no worries. I can do that for you.’
‘Big letters. Because I am worried. Dreadfully worried. I’m sick with worry.’
‘Just have a seat and I’ll see what’s what.’
‘What?’
‘Do you mind if we turn Judge Grinder down?’
I look at Simon, who doesn’t respond. He looks like he’s been watching TV for twenty years without a toilet break. I excavate the remote control and turn it down.
‘There! That’s better!’
It looks like Marjorie has been prescribed some morphine patches. I read the instructions, then go to put one on her arm.
‘But the pain’s in my back,’ she says.
‘I know. The medication gets absorbed through the skin.’
‘On my arm?’
‘Yes.’
‘But the pain’s in my back.’
‘Yep. You see, what happens is, the pain-relieving drug sinks into the skin, and makes the pain – erm – go away. It doesn’t need to be on your back.’ I try a different tack. ‘You swallow pain killers at the moment, and that helps your back, doesn’t it?’
‘I haven’t had any tonight. Should I have some now, d’you think?’
‘That’s not what the pharmacist is saying.’
‘What’s the pharmacist saying?’
‘To put this patch on your arm.’
‘But what about my back?’
‘I think this’ll help.’
‘I don’t.’
I stick it on, pat it for luck and toss the wrappings.
‘I’m just going to have a look at your new blister pack, Marjorie,’ I tell her. ‘You stay here and rest.’
I go into the kitchen. Judge Grinder returns to top volume.
I find the pack on the table amongst a litter of crap. When I turn round, Marjorie is right behind me.
‘Write it down!’ she says. ‘In big letters! So I can read it!’

Agnes doesn’t stand so much as get cantilevered into position by the riser chair. It’s a painstaking, precarious business. Just when you think she’s gained her centre of balance, she makes another tiny adjustment. I’m standing to the right, Grant, the OT, to the left, our hands out and at the ready like twitchy fielders at silly mid-off.
‘There! That should do it!’ she says, jettisoning the controls. ‘Now then. Where do you want me?’
Agnes is crippled by osteoarthritis. The medication she’s on, especially the steroids, have puffed her up until she’s as plump and dry as any of the scatter cushions tastefully spread about the place.
‘I used to be so house proud,’ she says, beginning the painful shuffle through to the bedroom. ‘I like everything just-so. All this chaos is just torture.’
‘You should see where I live,’ says Grant.
The porcelain dolls and antique teddy bears set about the place look as scandalised as if they’d all, at some point, been round to Grant’s flat. One of them has slumped over to the side. I set it upright again and the head falls off.
‘Jim doesn’t like dolls,’ says Grant as I faff around trying to make it right.
‘Doesn’t like dolls?’ says Agnes. ‘Why ever not?’
‘I keep expecting them to grab me,’ I say, finally getting the head back on.
‘Grab you? Why would they grab you?’
‘Exactly. That’s the thing.’
‘I don’t know what you mean.’
Grant high-fives a teddy as he passes and nods encouragingly at me. I grimace.
‘He’ll remember that,’ says Agnes, nodding at me.
‘Really?’
She laughs, and shuffles into position alongside the bed. We help her onto it.
‘See that black and white picture on the side there?’ she says, when she’s got her breath back.
‘Yep. Lovely. Is that you?’
‘No! That’s my sister, Ruth. She died this year.’
And suddenly Agnes is crying.
‘I’m so sorry,’ says Grant. ‘That must be very hard for you.’
Agnes squeezes her eyes shut and dabs at her cheeks with a tissue.
‘We used to talk every night on the phone. Oh – not about anything much. Silly stuff. What sort of day we’d had. I can’t believe I won’t hear her voice again.’
Grant pats her on the shoulder.
After a moment or two she gathers herself and brightens up, straightening up on the bed as much as her contorted spine will allow.
‘Oh dear, oh dear,’ she says. ‘This won’t do. Now then. What did you want to know about the bed?’

Derek from the Drugs & Alcohol team has come to visit Alfie. Not in an official capacity. He used to be a user and drinker himself and knows Alfie from the streets, way-back. He heard Alfie’s condition had deteriorated, and tracked him down to his flat on the other side of town to catch up on the old names and faces.
Derek is an impressive figure. A heavy set man in his late forties, brutally healthy, the scars on the great nub of his head as much a testament to his past as the crude, pen-stabbed tattoos on his knuckles. But his humanity is equally powerful. It radiates from him so warmly it lifts the room, transforming the degraded conditions – the grimy bed, the sticky floor, the fine dusting of fag ash over everything  – making it all seem tragic rather than simply wretched, something worthy of loving compassion. I can imagine him descending into the most appalling underground car park at midnight and lighting up every corner.
‘I’m still working on me African dream,’ he says, leaning forward and touching Alfie on the knee.
Alfie fumbles with his hearing aid.
‘What’s that?’
‘I said I’m still working on me African dream. I’ll be off to the Gambia before you know it.’
‘Oh, ay?’
Alfie looks a little tearful, but whether that’s because he knows he’ll be dead by the time Derek sets foot on African soil, or whether he’s thinking at least one of them made it out alive, it’s impossible to know.
‘Yeah,’ says Derek. ‘Me African dream. I’m gonna be buildin’ an ‘ouse with me girlfriend. You know ‘er, don’cha, Alf? That gerl from the Gambia? We’re goin’ back there together an’ we’re startin’ over. But don’t worry about me, mate. I’m not gonna get eaten by no crocodile. There’s not many big animals where we’re going, so I won’t get me ‘ed bit off by an ‘ippo. I aven’t seen too many ‘ippos in that neck of the woods. The biggest danger is that lunatic running the country. He could turn round at any time and say ‘Ere! I’ll have that house if yer don’t mind, thanks very much’. But what can you do, Alf, eh? You gotta take some chances, don’cha?’
Alfie nods.
‘No. Not too many ‘ippos. I tell you what, though. What they do got is bairds. There’s plenty of bairds there, Alfie. Big colourful ones. Big as dogs. Chatty ones. If you like your bairds you’re quids in.’

‘Now where have I seen you before?’ says Agnes, leaning back in the chair and sighting me along her nose.
‘Crimestoppers?’ (An old response to an old question. Sometimes it gets a laugh.)
‘Crimestoppers? What’s that? A television show?’
‘You’re thinking of Crimewatch, mum,’ says David, her son, coming in with her blister pack of medication. Crimestoppers is something else, something you ring when you want to report a crime.
She narrows her eyes.
‘No. It’s not that.’
I write out the paperwork; Agnes carries on staring at me intently. ‘Are there more of you?’ she says after a while.
‘What do you mean, are there more of you, mum? He works for the hospital. Of course there are more of him. At least I hope so.’
He nudges me in the ribs.
‘She’s not normally like this. She’s normally running round the house, tidying up, cooking, sharp as a whip. This infection has really knocked her for six.’
‘You’re very…. now what’s the word?’ says Agnes, reaching forwards and tapping me on the arm.
‘I don’t know, Agnes. Handsome? Debonnair?’
‘He’s very strong, mum, that’s for sure. See the way he helped you out of the chair like that? There  mightn’t be all that much of him, but I think he’s a bit of a pocket rocket.’
‘A what? No, no. It’s not that,’ she says. ‘You’re very…’
‘Funny? Kind? I don’t know. Humble?’
‘Very ordinary,’ she says, and then closes her eyes and nods, as if she’d just paid me the biggest compliment in the world.

These days, Frances doesn’t move much from her recliner chair by the window.
‘I like to have a good nose,’ she says. ‘And if it wasn’t for that damn sunflower I’d be able to nose a good deal better.’
‘I love sunflowers.’
‘My gardener put it there. He was so pleased when it came up. I didn’t have the heart to tell him it was in the way.’
‘It’s stunning. So yellow.’
‘Yes, but the glare.’
She stares out of the window, an impressive widescreen presentation of gardens and houses and roads all gently descending to a line of blue grey sea, tiny silhouettes of ships, and then the sky.
‘It’s quite a view.’
‘It’s why we bought it, Jack and me.’
‘How long were you married?’
‘Too long.’
She laughs and swipes the air.
‘I’m just pulling your leg. We had a wonderful time. Mostly. Sometimes you have to work at it.’
She stares out of the window again.
‘It comes and it goes,’ she says.
I finish writing my notes and then tell her what to expect in the coming days.
‘I don’t expect anything anymore,’ she says. ‘Don’t you know what this is?’
‘No. What?’
‘The Departure Lounge! I’m waiting in the Departure Lounge!’
She settles back in the chair and turns back to the window.
‘Trouble is, the bloody planes keep taking off without me.’

What I really need is a jetpack. With aluminium legs to hold my equipment as I buzz in low over the traffic. SatNav eyes. An aerial sticking out of my butt. And instead of this insipid blue nurse’s tunic, a black and yellow striped Kevlar onesie, with knee pads.

A busy day, however you cut it.

My happy-go-lucky, hail-fellow-well-met schtick has been replaced by something more sinister. An illegal hybridisation of Postman Pat and Liam Neeson. Helloooo Mrs Coggins. I have special skills.
And so the morning goes. Hunched over the wheel. Two more to go, then back to the hospital for a furious stint on the fax machine….

Mrs Ellis opens the door.

‘Ah! Thank you so much for coming. I’m sorry I wasn’t in yesterday, but then I didn’t know to expect you, otherwise I would have made arrangements. Do come in. I hope you won’t mind speaking in the lounge. My help has come like the angel she is and I don’t want to get in her way.’
It’s a warm and wonderful house, filled with colour and light, paintings and photos and drawings, alcoves filled with curios, a vibrant testament to the many years Mrs Ellis has lived there.
She sits on the sofa and places her hands in her lap. An elegantly dressed woman in her eighties, she has a mauve scarf tied round her head, dark lipstick, and her gnarled fingers are bristling with rings.
‘Now! What do you want of me?’ she says.
I run through the examination, review what’s been done, what’s coming up, who she needs to see next.
‘I must say you’re rather thorough!’ she says. ‘It’s all quite bewildering.’
Just as I’m writing my notes, she picks up a black paperback book from a coffee table.
‘I’ve been reading this,’ she says. ‘Being Mortal. Do you know it?’
‘Atul Gawande! Yes – I have read it.’
‘And?’
‘I thought it was really interesting. A bit drier than I was expecting, but he makes his case well.’
She strokes the cover of the book and suddenly seems quite distracted.
‘What did you think?’
‘Oh – I don’t know. Maybe it’s because it’s all a bit close to home.’
‘How d’you mean?’
She lays the book aside.
‘I have a friend. Ninety-two, a therapist all her life. Fantastically bright and still got all her marbles. But the thing is, she’s terribly lonely. Do you see? She’s so alone. And then I start to think about my family. How we all used to live here, and how busy it all was and that sort of thing. And now they’re off in China and America and Lord knows where, and here I am kicking around like a spare part wondering what’s going to happen.  It’s different if you have someone to talk to about these things, don’t you think?’
‘I do. Yes.’
‘Society has changed so quickly. Things have moved on. People live apart. You get left behind rather.’
She smiles at me.
‘But I mustn’t keep you. I can see you’ve got lots to do.’

‘You wouldn’t think to look at me, but I’ll be ninety-six next month,’ says Albert, holding on to the dining room table, his eyes dilute behind a pair of smeary glasses. ‘If you’d told me when I was in the middle of that blasted Burmese jungle I’d be standing here now like this, I’d never have believed it. You won’t be long, will ya’? Only Vera’ll wonder what we’re up to and come down.’ He leans in for a stage whisper and his glasses slide down his nose. ‘She hasn’t been quite right up here these past few months,’ he says, thumbing them back up. ‘We’ve been married God knows how long, and I’ve never known it so bad.’ He jabs out to the side with his elbow, makes a fist with his other hand, and letting go of the table, almost pitches backwards.
‘I’m sorry to hear it’s been difficult lately,’ I tell him, helping him into a chair.
‘Well – what d’you expect? You get as old as this, something’s bound to go off.’
I check his obs, but everything’s fine. He has an irregular heart rate – dropping a beat now and again, like the heart forgets what it’s supposed to be doing every so often.
‘I’ll need a specimen of urine, too, if that’s okay,’ I tell him.
It’s the focus of the visit. The GP has queried increased confusion and wants to rule out a UTI.
‘Gis’ your little pot here then and I’ll do it in the kitchen,’ says Albert. ‘It may take a little while. I’ve got that prostrate problem. But if you don’t mind waiting I’ll see what I can do.’
‘It doesn’t need to be a whole lot.’
‘It’s not going to be a whole lot.’
‘Like you say. Just do your best. You could always run the tap or something.’
‘Righto.’
‘Do you want a hand?’
‘How d’you mean?’
‘To walk in there.’
‘Oh! No! I’ll do what I always do. Which is not very much.’
I help him up, give him the pot, and he hobbles into the kitchen with it. He carries on chatting as he unbuttons his fly, positions the pot, and then stands there, half leaning against the counter, looking around.
‘I’ll just make a start on the paperwork,’ I tell him. ‘Shout if you need me.’

After a minute or two, when all I’ve heard is some muttering and low-grade cursing, I ask him how he’s getting on.
‘Nothing yet,’ he says. ‘I’ll keep you posted.’
‘Excellent.’
I carry on with the paperwork.

A minute later and he says: ‘You don’t mind, do you?’
I think he means him going for a wee in the kitchen, so without looking up I say that, no, of course not, he’s in his own house, he’s not overlooked…
‘Good,’ he says. ‘I was getting peckish.’
He’s eating a pork pie with his free hand.
‘Do you want some? There’s plenty.’

‘Do you want a cup of tea? I can run down and make you one.’
‘I can’t expect you to wait on me hand and foot… oh, all right then. White, none, please! That’s very kind.’
‘Well we can’t have our nurses going dry, can we?’
Deidre hurries off down the stairs.
I turn back to her mum, Frances, who’s sitting patiently on the side of the bed.
‘What do you want to do first?’ she says.

Frances broke her wrist the other day. It’s back-slabbed now, waiting for the swelling to go down and a fracture clinic appointment in a couple of days. Till then she’s stymied, unable to dress, shower, wash up, feed herself. Not that those things were happening much lately, anyway. Frances’ dementia has been getting worse, her benign confusion sliding into a more profound and dangerous lack of self-awareness. Despite three carers a day, it was already looking like she’d have to move somewhere safer. Deidre has already told me she’s actively looking for a care home.
‘There you go!’ says Deidre, bustling back in the room and holding out a strong cup of tea in a mug with a kitten on the side. ‘Nice n’strong to keep you awake.’

She watches as I run through the examination.

‘You’re my best patient today,’ I tell Frances as I unclip my stethoscope. ‘Mind you, I’ve only just started, so…’
‘Cheeky!’ says Deidre. ‘Don’t listen to him, mum.’
‘Where’s my tea?’ says Frances.
‘There, on the side. No – your good side.’
‘Oh. Right you are.’
‘We used to have a kitten like this,’ I say to Deidre, taking a sip of tea and then holding up the mug. ‘Whenever it had that expression on its face, you knew it was planning something spectacular, like sprinting across the room, running up the curtains and swinging from the pelmet.’
‘Where d’you get him from, then? The circus?’
‘Nah. The RSPCA.’
‘I like cats. They’re all a bit crazy.’
‘Who are?’ says Frances.
‘Cats, mum.’
‘Oh. I thought you meant me.’
And she raises up the arm with the cast, like it was the craziest thing of all.

Mary hasn’t made it to the intercom yet, but whilst I’m waiting a guy on the ground floor comes out. I think my uniform, badge and equipment probably reassure him I’m bona fide, but just as a little extra I tell him I’m here to visit flat twenty-one.
‘Good luck!’ he says, holding the door open and slapping me on the shoulder as I pass.

She’s waiting for me in the dark cave of her hallway, hunched over and scowling like an ancient, denuded bear, furious to be found still in her nightie.
‘I haven’t had my peach yet,’ she snaps, turning and shuffling back into the bedroom.
It’s quite a contrast to the hallway, a wide, bay window overlooking the local park, bright morning sunshine filtering through trees, joggers in fluorescent tops running round the perimeter, a collie dog leaping for a frisbee.
‘Great view!’ I say, putting my bag down.
‘ Great view? What good’s a view to me?’ she says. ‘How’s a bit of green supposed to help? I’m sick. My back’s killing me, my eyes are falling out. I’ve got no appetite. I suppose you think I’m rich? This isn’t my flat, you know. It’s council. Or housing association. Same thing. Just ‘cos you can see a few trees out the window doesn’t mean I’ve got money to burn.’
‘No. I’m sorry you’re not feeling so good today, Mary.’
‘You don’t know the half of it. But what do you care? That doctor was here last night. I’d just started telling him how I was and suddenly he says: That’s it! That’s your eight minutes. I’m off. And anyway, where do they get off telling you not to eat and smoke when they’re the worst of the lot?  You see ‘em all out there, stuffing themselves with crisps and fags. Nothing surprises me anymore, though. No-one cares. I went up the hospital for that MRI the other day. The ambulance what took me might as well have been loading a wardrobe. They slung me in the back and then rode me all round the houses. I could hardly keep myself in the chair, my bits and pieces flying everywhere. Ooh you do look ill says the nurse when I got there. Is it any wonder after a shocking ride like that? I said. But she didn’t want to know. And then I was hours waiting before they picked me up again. The journey back was even worse. I said to them: Are you trying to kill me or what? But they didn’t say nothing, just smiled at each other like it was some kind of joke. Then they tipped me out and went down the pub. They looked like drinkers. I know the signs. My dad was the same. My poor old mum didn’t have two halfpennies to rub together but he always managed to find enough to spend every night down the boozer.’
She pulls on her dressing gown, tightens the cord and frowns at me.
‘And watch out when he came home,’ she says.