the three bears

There aren’t many things I remember from Geography class, but one of them is the oxbow lake. It’s that thing that happens when a river meander gets loopier and crazier until the river nips it off at the top and leaves it to one side as a curved body of water. (Note to reader: I did NOT score highly in my Geography exam).

This close reminds me of an oxbow lake. The main drag thunders across the top, leaving a U-bend of terraced houses with a thin strip of wasted grass and brambles in the middle. Driving round it, I can’t figure out the numbers at all. It’s as if they built the houses first, then took a bag of numbers, shook it up, and ran round throwing them randomly at the doors. I can’t see any sequence to it at all – and worse than that, I can’t find any sign of a number eleven. (Note to reader: I did NOT score highly in my Maths exam).

There is an unnumbered door round the corner from number nine, though. So although strictly speaking it should count as an address on the main road, I take my chances and my bags and go down the cluttered path to knock on the door.

There’s a long wait, then the sound of someone clumping downstairs.
The door gets thrown wide.
An elderly woman with thick round glasses and a startled expression.
‘Hello!’ I say. ‘I’m Jim, the nursing assistant from the hospital. I rang your carer Stevie and she said it was okay to visit. Are you Agnes? I’ve come to take some blood!’
I extend my ID badge on its elasticated string but she doesn’t look at it.
‘Come on, then!’ she says, batting the air. ‘Follow me!’
She turns and stomps back up the stairs.

I’m encouraged by how full of life she seems. The Doctor had asked us to visit today as a one-off for bloods and a set of obs. The community phlebs were full so it was a bit of a favour.
‘I didn’t like the sound of it,’ the doctor said. ‘The carer was talking about jaundice and abdo pain. If you could take a look for us that would be great.’

I put the rest of my PPE on in the hallway and follow Agnes up the stairs into her sitting room.
She’s already back in her chair – a throne of white cane, padded with red and yellow cushions and set in the middle of the room, with a card table next to it for her biscuits and orange squash, telephone and remote control. She’s watching Flog It! A punter and a dealer are sitting either side of a table looking down on a tiny vase; the dealer starts laying out lines of twenty pound notes. Uh-huh! says the punter. The dealer lays out some more. ‘Try harder’ says the punter.

‘You’ve come for my blood!’ says Agnes. ‘You’d better be gentle!’
‘How are you feeling?’ I say. ‘Stevie said you haven’t been yourself lately.’
‘Who’ve I been then?’
‘Well. She didn’t go that far.’
‘No. I bet she didn’t.’

Lined up on a small sofa behind Agnes are three bears: one giant polar bear, one medium-sized grizzly bear and one small teddy bear. The teddy bear is perched on the lap of the polar bear.
‘They’re giving me a funny look,’ I say, nodding at them.
‘They do that with everyone,’ says Agnes. ‘Just ignore ‘em.’

We chat about how she’s been feeling. I take a history, give her the once over, take her observations.
‘All good!’ I say. ‘So tell me again how this all started.’
‘It was that burger,’ she says. ‘It was all mushy. And mayonnaise? That wasn’t mayonnaise! It was lumpy and grey.’
‘Eurgh! Doesn’t sound good.’
‘No. It wasn’t good. And that was the start of all my troubles.’
‘Have you felt sick? Or been sick?’
‘No.’
‘Have you had any diarrhoea?’
‘No. I went this morning.’
‘And was that all normal.’
‘Depends what you call normal.’
‘Well – firm. Fully formed.’
She pulls a face.

Behind me in Flog It! things are getting serious. The dealer has spread out a whole wallet of notes now, but the punter folds her arms and leans back in the chair. I can’t believe a tiny vase could be worth so much.

‘Any pain?’ I ask Agnes.
‘A little. Round my middle.’
She makes a sawing motion with the flat of her hand.
‘Sorry to hear it. Is it there now?’
‘No.’
‘Have you taken anything for the pain?’
‘What like?’
I shrug.
‘Paracetamol? That’s quite effective but shouldn’t upset your tummy any more.’
‘I haven’t got any.’
‘Maybe Stevie could get you some.’
‘Maybe.’
‘I’ll talk to her. So – Agnes? Have you had this pain before?’
‘Oh yes.’
‘Tell me about that. When was the last time?’
‘A couple of months ago.’
‘And what happened there?’
‘I had a chilli.’

The punter has taken the vase and put it back in her bag. The dealer is shaking his head and clearing the cash away.

‘Do you mind if I put the light on?’ I ask Agnes. ‘Only Stevie said you were jaundiced and I need to get a better look.’
‘Help yourself. The switch is over there.’
The moment I put it on the room is flooded with light. It’s made more pronounced by the lack of a lampshade, but even so it’s astonishing how powerful that bulb is – like I didn’t throw a sitting room light so much as shoot a flare overhead.
‘Wow!’ I say. ‘That thing’s bright! I need welding goggles.’
‘I like to see what’s happening in the world,’ says Agnes. She thumbs at the bears behind her. ‘And so do they.’

sugar coating

The night has been long and cloudless, so cold that everything is locked in a thick hoar frost. A crystalline web sags heavily on Mr Rawlinson’s front gate. I imagine the spider that spun it must be something of a jewel itself now, glittering like a leggy diamond somewhere, deep-frozen in its lair.

Mr Rawlinson is luckier than the spider, though. His bungalow is filled with a fulsome warmth that seems to ripple as I move into it.
‘Come in! Come in!’ he says. ‘And be quick about it.’

We’re short on carers this morning, so I’ve been asked to drop by. Looking at Mr Rawlinson, I wouldn’t think there’s much to be done, though. Not only has he managed to wash and dress himself, but he’s done it so well he looks almost too perfect, standing straight-backed, holding on to his kitchen trolley, a pensioner on parade. It’s like a team of make-up artists has been challenged to put together the most perfect pensioner they can, and really, they’ve excelled themselves. Mr Rawlinson’s silvery hair is brushed to the left and the right of a geometrically precise parting, his moustache perfectly trimmed, his shirt buttoned to the neck with a blue tie in a Windsor knot symmetrically in place; cuffs sharply in line; cardigan just-so; canvas trousers with pleats like origami folds, and slippers so buff I imagine a valet must have been fussing over them with a monogrammed brush moments before.
‘Are you here to fetch me breakfast?’ he says.
‘Absolutely. Whatever you need.’
‘Smashing. I’ve left it all ready to go. The bowl, the muesli, the sugar and so on. I’d like a portion of muesli, some milk in a jug, a slice of toast with thick-cut Oxford marmalade and a cup of Earl Grey tea, medium strength. Are you okay with all that?’
‘No problem.’
‘Splendid.’

I’ve been given the job on the fly, so I haven’t had a chance to read his notes. It strikes me that Mr Rawlinson is functioning extremely well, and I wonder why the care has been requested. After all, it’s not too much of a stretch to put muesli in a bowl, especially once you’ve gone to the trouble of setting the packet and the bowl out in the first place. But maybe I’m missing something. It could be that without a carer coming in to supervise these things, he’d hit the skids and wouldn’t bother. I’m happy to oblige, of course, but I make a mental note to follow-up the job when I get back to base.

‘Why don’t you sit down at the table and I’ll bring everything over?’ I say to him.
‘Righto!’
‘I thought this muesli already had sugar in it?’
‘Yes, you’re right, it does, but I like it sweet. Three sugars in my tea, as well, if you wouldn’t mind. When you get to my advanced old age, a few extra spoons can’t hurt.’
‘That’s true.’
I fold a square of kitchen towel into a triangle and put it with the point towards him on the table, followed by a knife, dessert spoon and teaspoon. He adjusts the angle of them, to line up more precisely with the napkin.
‘When I was in the RAF,’ he says, folding his arms, ‘there was a chap there, forget his name, Canadian, I think. The most athletic man I have ever met. Played any sport you could think of, and probably a few others. Mostly one of those track types. You know? A runner. Faster than a blessed hare. Well! He used to do it all, sugar, tobacco, alcohol – you name it.’
He finesses the cutlery a little more.
‘Maybe it would have had some effect eventually,’ he says, after a moment. ‘But we were never afforded the privilege of finding out, of course. The poor chap was shot down somewhere over the Atlantic.’

pugs!

If you work on the coordination desk long enough you’ll feel yourself change.

Nothing dramatic or immediate, but imperceptibly, stealthily. It’s a hazard of the job, the frantic business of it, tapping away at the computer keys, answering two phones at once, taking questions from colleagues who wait in a restive line like shoppers at the Deli counter. A function of the distracted firing of your brain cells, the agitated beating of your heart, the immobility of your body in the chair. All these things will take hold, come together and warp you at a genetic level, cannoning your atoms into novel patterns like a drunken God with a billiard cue until – too late – you realise you ARE the phone, you have BECOME the computer, you have ABSORBED the notepad. You’ll only notice at the end of the day, when you go to stretch and your arm snaps in half because it’s changed into a pencil. Or you roll your neck to ease the cramp and your head logs off. Or you go to stand up but you can’t because your vasculature is now the furniture and your spinal cord has extended through the floor tiles and uploaded you to the network.

That’s the down side.

The upside is that eventually you’ll find yourself in synch with the office. You’ll be tuned-in to everything happening around you without even trying. You’ll be working the desk like a dreaming, caffeine-crazed spider, a little bored maybe, a little restless, your compound eyes flickering with the light of the database, whilst you unconsciously monitor the action around you by the vibrations you feel through your feet.

Which is a complicated way of saying I was aware Karen was on the phone before I really knew it.

Sophie was talking to her. Sophie is one of the administrators. She’s on the frontline of the operation, taking calls, giving information, directions, advice, or deciding where to redirect – which more often than not means patching them through to the coordinators. Sophie is great at her job. She’s warm and friendly, however long the day or trying the circumstances. I love the way she answers each call with the same intonation – saying the company name with a flourish like she was throwing a fancy tablecloth over a workbench. But then her tone changes immediately, coming down a notch, and within seconds she’s speaking to the caller as if she was gossiping with a favourite aunt.

Only this time, she wasn’t.

Sometimes even Sophie struggles to connect with the caller – especially if the caller is Karen.

Karen has been referred to us many times before. She’s difficult, in the way that Medusa was difficult, except in Karen’s case it’s not snakes but pugs. She lives in a state of constant war with everyone and everything, storming through the world with a half dozen pugs clutched to her chest, their bug eyes an expression of the stress she’s under, or the strength of her grip, or both.

I zone into the conversation half way through.

‘…Karen? Karen? I’m afraid you’ll have to put the dogs in another room or something because I can’t hear a word you’re saying…. Karen? Karen? Honestly – it’s impossible. Put the pugs in another room, Karen. Yes. That’s right. Another room. And shut the door… I’m sure they’ll be fine… it’s just for a minute, Karen, so I can understand what the problem is. Lovely. Thank you. Could you start again, please? …. Okay… Okay…. So you need help of some kind, is that right? A nurse. Okay. Well – I see from the notes here that a nurse came round to see you about an hour ago and you didn’t let them in… Is that right, Karen? …. Okay…. Okay…. Well, as I’m sure you’ll appreciate, it’s difficult for us to specify male or female… No, Karen. They’re all nurses. They’ve taken the same qualification…. It’s very difficult to do that, Karen. We can try, but it may mean a delay in getting you the help… Yes. I understand that, Karen…. I’m sorry you feel that, Karen…. but they probably only knocked like the police because they didn’t know whether you’d heard them or not… Well, because of the dogs barking….Yes, well, I’m sorry your dogs were upset by that… I’m sure they do… Karen? If you want to put in a complaint you’re more than welcome to do so. But if I could just… if I could just… No, that’s not what I’m saying, Karen…. if I could just…Have you let the dogs back in, Karen?..Karen…?’

Sophie holds the phone away from her ear, catches my eye, shakes her head, plunges back in.

‘Let me put you through to Jim,’ she says. ‘Maybe he can help…’

She punches in my extension.

‘Karen for you,’ she says when I pick up. ‘Good luck.’

And when my phone connects, it’s like a bone being tossed in the middle of a dog fight.

‘Karen? Karen…?’

raiders in the sky

Bill is sitting in his lounger, his black velcro support boot up on a stool, one hand draped over a walking stick. He’s watching an old British war film, Dirk Bogarde tapping a map of Europe with his swag stick, laying out the bad news with a ‘look here chaps’ and a ‘jolly decent of you old boy’ whilst the room of bomber crews heckle him respectfully and laugh heartily but fall silent just as quickly because anyone can see the whole thing looks like a bally serious show.
‘I’ve brought you that stuff!’ I say, struggling in with a perching stool, urinal bottle and pressure relieving cushion. ‘Happy Christmas!’
‘That’s very good of you!’ he says. ‘Where you’ll put it all, I don’t know.’
‘Well – the perching stool goes in the bathroom, you sit on the cushion, and the urinal sits by the bed.’
‘It’s not a big bathroom,’ he says. ‘But you’re welcome to have a look.’

He’s right about the bathroom. There’s just enough space to put the stool in front of the sink and still be able to open the door to get in. It’s a bleak but well-ordered room, one toothbrush and one shaver on a single glass shelf, a soap dish, a mirror, a towel. I experiment with a couple of positions, then leave the chair square on to the sink and go back into the living room.

The briefing has ended. Dirk Bogarde is having a chat with one of the lower ranks, a buck-toothed cockney sergeant who screws up his cap as he tells DB he’s married with six kids and how she’ll cope this Christmas without him he don’t know. Dirk Bogarde puts a hand on his shoulder and winces, which doesn’t bode well for the mission. But the cockney sergeant doesn’t seem to pick up on it, thankfully, and the sergeant and the scene move on.

‘See what you think,’ I say to Bill as I go back through. ‘I think you should still be able to get in and out alright. You and your leg.’
‘I’m grateful,’ he says. ‘Sorry to drag you out at Christmas.’
‘I was working anyway. It’s a pleasure. Ho ho ho.’
‘Yes,’ he says. ‘And a ho ho ho to you, too.’

Whilst I check Bill over for blood pressure, SATS and so on, the film cuts to a montage of mechanics putting the last touches to the Lancaster bombers, the crews clambering into the cockpits, going through their flight checks, calling out this and that, waving cheero, snapping on their masks.

‘Could be worse,’ I tell him, looping the stethoscope back round my neck.
‘What – my blood pressure?’
‘No. We could be at war. Anyway – your blood pressure’s fine, Bill. Better than mine.’
‘Is that right?’ he says. ‘Well. Something’s working, then.’
‘So how come you fell and broke your ankle? I didn’t get the full story.’
‘Me neither. One minute I was getting out of bed, the next I was lying on the floor with my leg twisted under me.’
‘What did the doctors say about it at the hospital?’
‘I don’t know. And I didn’t care to ask.’
‘Oh? Why not?’
‘Well. They might turn round and tell me.’
‘That’s true enough.’

We both look at the TV. The bombers are leaving, one after the other, a flock of monstrous black birds roaring off into the night.

‘Lock the door on your way out,’ says Bill.

the great conjunction

Saturn and Jupiter are lining up.

Apparently it’s a thing that happens every twenty years, but a great conjunction, where the two planets get so close they look like a single bright star – well, that only happens every four hundred years or so. Kepler, the seventeenth century astronomer, pointed out that a great conjunction happened in 7 BCE, and may account for the Star of Bethlehem in The Nativity.

Today we’ve had nothing but thick fog and a cruel variety of fine, saturating rain that makes walking forwards feel like swimming up. It was just as well the weather was kinder all those years ago in Bethlehem, otherwise the Birth of Christ would have featured a comedy moment where three bedraggled kings holding fancy boxes over their heads high-step three hours late into an empty stable where an innkeeper is sweeping up.

Two thousand years back in the CE, though, Saturn and Jupiter aren’t the only things lining up.

Karen, the physio, is waiting for us under the porch outside Mr and Mrs Billingham’s house. She’s brought a walking stick. Jack the carer is here for a lunchtime call. I’ve turned up to deliver and fit a shower stool and a toilet frame, and to do some obs. There’s not much room under the porch, so I’m at the bottom of the steps leaning in.
‘I’ve rung the bell but nothing’s happening,’ says Karen, her eyes smiling above her mask. ‘I’m not even sure it’s working.’
‘Shall I knock?’ says Jack. He goes up to the door – an iron-bounded oak affair, with a door knocker so huge it wouldn’t look out of place on a quayside with a ship tied up to it – and flips it three times.
‘It’s like Jack and the Beanstalk,’ I say. ‘When he goes up to the castle and knocks.’
‘Have you met Mr Billingham?’ says Jack. ‘I don’t think ogre is far off, as it goes.’
We wait.
The house is silent.
‘Are they in?’
‘They don’t go out.’
‘Do you think they’re in?’
‘Hang on…’ says Karen, leaning into the door. We all listen.
‘No. Sorry,’ she says, straightening up again. ‘I thought I heard something.’
Jack sighs.
‘This is ridiculous,’ he says. ‘We keep coming back, and the same thing keeps happening.’
‘He’d better hurry up,’ I say. ‘I’m worried about this shower stool getting wet.’
They both laugh.
‘Actually – aren’t they designed to get wet?’ says Karen.
Jack gets his phone out.
‘I’ll ring him.’
Amazingly, Mrs Billingham picks up almost immediately. Karen and I only hear half of the conversation, but this is roughly how it goes.
‘… we’ve come to see how you are, Joan…. because the doctor asked us to…. you had that fall, didn’t you? And people were worried… well… Joan… actually it isn’t that early. It’s lunchtime, Joan… that’s why I’m here, to help you get something to eat and whatnot… and I’ve got some other people here to see you, too… colleagues of mine… well, there’s Karen, the physio, she’s here to help you get back on your feet… and there’s Jim, the nursing assistant to make sure you’re okay, and to put in some equipment to help with this and that… we talked about it the other day, d’you remember?…. yep… yep… but Joan… yep… yep… Joan?… the thing is, we really need to see you today… no, the phone doesn’t really count… we need to clap eyes on you, to make sure everything’s okay… yep… sure, put him on….’
Jack widens his eyes at us and breathes out heavily, which immediately steams up his glasses. Then Mr Billingham comes to the phone and Jack starts up again:
‘…hello ….Mr Billingham? …. it’s Jack, the carer. Hi! We met the other day? How are you?… yep… and I’m sorry to disturb you… well – I did phone ahead, but the phone cut out… no, a few times…. yep… I appreciate that… yep… I know you’re in bed… but the thing is, Mr Billingham, we really need to see Joan… because the GP asked us to… he’s worried, Mr Billingham… yep… yep… I understand that… but the thing is, Mr Billingham – with the greatest respect – Joan is our patient. She’s our responsibility. And that’s why we need to see her for ourselves….’

The conversation carries on like this for some time. He persists long after I would’ve given up, and I’m impressed with Jack’s patience. He doesn’t raise his voice or start to sound hectoring or patronising at all. Instead, like some accomplished hostage negotiator, he makes subtle changes of argument, trying to coax Mr Billingham downstairs to unlock the front door and let us in.

Meanwhile, more people have started to arrive. Two representatives of the care agency who’ve come to do their initial assessment. They’re bulky, approximate figures, swathed in enormous parka coats, the furry hoods up, tightly clutching blue folders to them like aliens holding manuals to life on Earth. Next is another figure in a smaller but still pretty substantial shiny black puffa jacket, with some kind of Norwegian hat pulled hard down over her head, the ear flaps resting on her shoulders. When I nod and smile at her she just sways a little from side to side and bobs at the knee. I get the impression she’s a social worker. Last to join the line is a postman. He’s like the Royal Mail version of Lear on the heath, his long grey hair completely soaked and bedraggled, his beard, too. All he has on are a lightweight jacket and cargo shorts, none of which would be any good on a summer’s evening, let alone the current horror show. He’s weighed down by an enormous mail sack, of course – but he seems remarkably chipper.
‘What’s up?’ he says from the back of the queue. ‘Are they having a sale or something?’
Before anyone can answer he taps the social worker on the back.
‘Here ya go, Pingu,’ he says. ‘Pass these along and stuff ‘em in the box, would ya?’
Then he waves and marches off.
The letters make their way forward. I hand them to Karen, she hands them to Jack, who – still talking on the phone and cradling it to his ear – pushes them through the letterbox.
‘Mr Billingham! Your mail’s arrived!’ he says as he does it. ‘Some exciting looking envelopes… cards and all sorts … why don’t you nip down and have a look…?’

the test

I had an appointment for a swab at the Walk-in Covid Testing Station at the local park. I’d developed a cough, and although I had no other symptoms and felt quite well, still, I needed to have confirmation I wasn’t infected.

It was around five o’clock. Temporary floodlights brutally illuminated a series of chain link safety fences; two walkways of interlinked boards that led into a gap marked ENTRANCE and then out of one marked EXIT; a white portakabin,and then the big, white marquee beyond. It looked like some kind of festival, except – a particularly bleak and sinister one, held at night, where you’re the only guest. There was a Covid marshall in a visor and surgical mask, hi-vis tabard, beanie hat and boots, stamping and rocking from side to side, blowing into his cupped hands.
‘Alright?’ I said as I approached.
‘Blinding!’ he said.
He made a gesture with his right hand, the cliche kind of thing you see in spy films when the tough border guard demands to see your papers. I showed him my phone, and the thing I’d downloaded from the government site. He scanned it.
‘Go on, then,’ he said. ‘Knock yourself out.’ Then holstered his scanner, and carried on stamping.

I followed the walkway through the fence and the rolled-back flaps of the marquee. There was a test official waiting for me by a camping table laid out with sealed packets and things. He was friendlier than the door guy, but I thought that was only because he was standing by a patio heater.
‘Hello!’ he said, beaming behind his visor. ‘Can I see your appointment code again, please?’
I showed him the phone.
‘That’s great!’ he said. ‘Lovely!’ And handed me a pack.
‘Just find yourself a cubicle and follow the instructions,’ he said. ‘I’ll pop in and see you’ve got everything you need and know what to do. Okay? Great!’

The marquee had been divided into thirds by two huge sections of canvas running the length of the space. The middle third was left clear – just a stretch of grass and the metal walkway down the centre; the remaining thirds were subdivided horizontally into cubicles by smaller canvases. There was clear plastic at the entrance to each, like windows. I went into the nearest empty cubicle, although – to be fair – I could’ve used any of them, because the place seemed pretty empty.

I sat down at the camping table they’d set up for the test, put my pack in front of me, and started to read the instructions. The test official hooked back the flap of my cubicle and looked in.
‘Alright?’ he said. ‘Got everything you need?’
‘Yep. It all seems pretty straighforward. Anyway – I’ve done it before.’
‘Oh?’ he said. ‘Experienced!’
‘Yeah. A drive-in place.’
‘Really?’ he said – but that’s as far as it went. There didn’t seem an awful more to say about it. To fill the dead air, I suppose, I said the first thing that came to mind.
‘I wasn’t sure about the app,’ I said.
‘Oh? Why?’
‘When I used the Q Code it took me to a strange place.’
‘What strange place?’
‘Oh – some website. I don’t know what it was. Lots of links and things.’
He widened his eyes above his mask.
‘Mmm!’ he said. ‘Where do you think THEY led to?’
‘I don’t know,’ I said. ‘Somewhere amazing, probably.’
‘Well!’ said the official. ‘Maybe next time you should click.’
‘Maybe I should.’
He stayed there a second more, kind of swinging on the flap. Then he straightened up and pointed at me.
‘Shout if you need anything!’
‘Will do!’ I said, trying to match his energy but blushing instead.
He left.

I opened the packet and lay out the kit, cleaned my hands with the alcohol gel, and got ready to swab my throat and nose. There was a little round hand mirror on the table, so I used that.

In my own defence, I think the cough had sensitised my throat. I mean – last time I did the swab I retched a little. It’s not a great feeling at the best of time, paddling a giant cotton bud around at the back of your throat. Today, though, was especially difficult.

I made such a fuss about it the guy came back.
‘What on EARTH is going on?’ he said, swinging on the flap again. ‘We’ve had some gaggers in today but you’re the absolute WORST!’
‘Sorry!’ I gasped. ‘I’m finding it hard today.’
‘You certainly are!’ he said. ‘You sound like a cat with a hairball. You sure you’re okay?’
‘Yeah. I’ll be fine.’
‘Well – alright then. But you be careful what you put down there. And see me when you’re done.’

The nose was easy after the throat. I shoved the business end of the swab into the phial of liquid, snapped it off, screwed on the lid, put one thing inside another in the way the instructions directed, then cleared up my station and left the cubicle.

The test official was there, waiting.
‘This way!’ he said, and I followed him down the bouncing metal walkway to another long camping table, this one set up in front of a larger cubicle with a clear plastic hatch.
‘Another customer for you, Malcolm!’ he said, leaning on the table. Malcolm didn’t seem enthusiastic, though. He was waiting just the other side of the hatch, so motionless he could’ve been a mannequin dressed in PPE, there to make the place look busier. But then he moved, and asked me in a bored voice to hold up my pack so he could scan it. After the beep he pushed open the flap for me to drop the pack into the bin the other side. I wondered whether they swapped jobs from time to time, just to liven things up, but I didn’t feel able to ask.
‘Thanks so much!’ I said, as if they’d just treated me to an amazing dinner.
‘You’re VERY welcome!’ said the test official. ‘And DON’T go following any strange numbers!’

I left the marquee, following the boards, eventually leaving parallel to the ones I’d used to enter the place. The marshall was still there, doing his wintery, side-to-side shuffle. He was right under the halogen scene lights, picked out like an actor on stage. It would’ve been great to see him launch into a Kung Fu routine. But he didn’t.
I waved to him; he nodded back.
‘Have a good night!’ I said.
‘You’re kidding, right?’ he said.
I shrugged, shoved my hands my hands deep in my pockets, headed for the car.

return of the pedalo kid

I’ve been coordinating all day. Which isn’t a plea for special consideration, more just a recognition of a physical fact, like admitting the Atlantic is pretty big, or yes, on balance, it’s probably true, the Himalayas can be bumpy. I’ve been shackled to the galley of this desk, working the keyboard and the phones, from half past seven in the morning, with everyone breezing in bright and fresh and grabbing coffee, to seven in the evening, most of the crew gone, the dishwasher churning in the background, the motion sensitive lights starting to click off, and a radio playing Christmas songs on a loop in the background Twas Christmas Eve babe…in the drunk tank…. There are only a few of us left now, the stragglers, the no-hopers, the hangers-on, the lost. One of the latter, Will, is a new physio, struggling to finish his paperwork. I’ve helped him out with bits and pieces, but he still has a way to go. He keeps coming up to the desk, holding his laptop in the flat of his hands like he’s offering up a bird with a broken wing that he doesn’t think can be saved.

I’ve been wearing a mask all day, too, which doesn’t help. It’s like having your head under the duvet, which – after eleven hours of coordinating – is a dangerous state of affairs.
‘That last call took me way longer than I expected,’ says Will, approaching the desk with his laptop again.
‘It’s tricky, to begin with. There’s a lot to think about. You’ll get quicker.’
‘Yeah. Also….the family were quite challenging.’
‘Were they? In what way?’
‘Oh – he was alright. It was his wife. Mrs Tuttle. She was quite hostile. I don’t think she wanted me there.’
‘Let’s take a look…’
I call the patient’s records up.
‘Hmm. It says here the last time he was on our books, about six months ago, we had trouble getting access. Looks like she didn’t want anyone coming in the house. Concerns about Mr T. Social workers … dah, dah … yep, definitely sounds tricky. We’ll have to go carefully. I think you did an amazing job to get as far as you did, Will.’
‘Thanks,’ he says. ‘I took it slow. Which I had to do anyway. It’s just…’
‘Go on..’
‘You couldn’t call her, could you?’
‘Who? Mrs Tuttle. Of course! What for?’
‘Well – I had to get out of there pretty sharpish in the end, and I wasn’t sure she really understood about the way it works with the carers.’
‘I can explain it to her. No worries.’
‘Thanks. lt’s things like letting her know that they can’t ring before they turn up. Also that they’ll be respectful about waiting before entering the house. And the kind of things they’ll do when they go in.’
‘Absolutely. I can do that.’
‘Thanks!’ he says, looking relieved. ‘I don’t think I could face talking to her again.’
‘How bad could she be?’
He smiles at me, then slowly backs away.

I have to admit, helping Will like this feels good. It makes me feel like an old hand. I’ve visited so many patients now, in the ambulance and in the hospital avoidance team. I’ve seen it all, good and bad. I see myself as Will no doubt sees me – one of those helpful, easy-going, thoroughly competent colleagues who’ll always be there to pour oil on troubled waters. I sigh, lean back in the chair. Pick the phone up. Hang the mask off my ear like a marine. Check the number. Punch it out.
When the phone picks up I introduce myself.
‘Why are you ringing?’ says Mrs Tuttle. ‘The other man was only here five minutes ago.’
There’s a formidable clip to her voice that immediately registers. I feel like I’ve put to sea drunk in a swan-shaped pedalo and woken up five miles offshore. In the rain.
‘Yes. I know. That was Will. The Occupational Therapist.’
‘Oh! Well. He told me he was a Physiotherapist.’
‘Yes! You’re right! Sorry. That’s what I meant. Physiotherapist.’
I want to tell her that he’s only just started here and I was momentarily confused, but the words burn away just as surely and instantaneously as my sang froid.
‘It’s just like the hospital,’ she carries on. ‘They tell you one thing and do something completely different. They say my husband won’t be coming out for a week and then five minutes later I’m called by the ambulance to say he’s on his way. They promise the earth and give you nothing. And now you.’
‘Well. Yes. It must be frustrating.’
‘Frustrating?’ she says. ‘Would you mind waiting there a second?’
‘Of course.’
‘I’m just going to put on the recording device.’
‘Absolutely.’
Recording device.
‘There!’ she says. ‘Now. Start again please. Tell me your name, your job description, and the purpose of your call.’

a second set of clothes

‘They said there’s nothing more they can do for Jean. They said it’s terminal. Do you think that’s right? Do you think there’s anything more to be done?’
Stan’s eyes bore into me. There’s a slack and waxy look to his face, like he hasn’t slept for a week.
‘I don’t know, Stan,’ I tell him, and look down again at the discharge summary in my hands. The journey Jean has taken from ambulance admission to A and E and then back again is described in lean, jargonistic language, but no less damning for all that.
‘What did they say at the hospital?’
‘Not much. But then a doctor came round here the day after Jean came home and said that was it, basically.’
‘It’s so hard,’ I say. ‘How are you bearing up?’
He massages one fleshy hand with the other, working the thumb into the palm, like he only needed to get a little strength back there and he’d be able to do something, to make some change.
‘I’m used to sorting things out, getting things done,’ he says. ‘I’m the one they all came to. I even organised the skiing trips. But this? I just don’t know. I just don’t know.’
‘Do you have family around, Stan? Friends, neighbours?’
‘We didn’t have children,’ he says. ‘Not that it bothered us, after a while. We had Jean’s family, our friends, of course. They’re all elderly, now. Half of them are dead. I think I’m the only man left amongst the old lot. So – what do you think? What should I do?’
I lay the discharge summary gently on the table, beside the DNACPR and the scrip for the anticipatory meds.
‘You know – just reading what the medics have written here, it does look like Jean’s cancer is untreatable. So the thing is to take care of her at home now, if that’s what you both want. It’ll be about symptom control, making Jean comfortable. Have the palliative team been round yet?’
He nods.
‘There’s been a lot of people in and out.’
‘It gets confusing. Whoever comes in should write in the folder here – who they are and what they’ve done – so there’s that. And there’s a list of the main numbers to ring if anything changes or you’ve got any questions. I’ll give the palliative team a call in a minute and ask where we are with visits and things. What to expect next.’
‘They left all these medicines. What am I supposed to do with them?’
‘Those are what they call the Just in Case meds. It’s things for pain relief, to help Jean’s breathing, anti-nausea meds, that sort of thing. You don’t have to worry about them, Stan. The District Nurses will be in to take care of all that. Is that okay?’
‘I suppose it’ll have to be.’
‘They’ve referred Jean to us for some urgent equipment and care support.’
‘Right. Got you.’
I wait a minute, then stand up.
‘What d’you think? Shall we go up and say hello to Jean?’
‘Yes. Sorry,’ he says. ‘It’s funny. She’s normally up with the lark, but she’s feeling pretty worn out so she’s staying in bed.’
‘I don’t blame her.’

He leads me up a narrow, carpeted staircase, worn to the thread in the middle, the boards sagging and creaking. The landing window is open and an unseasonably warm afternoon breeze nudges through the curtain.
‘Jean?’ says Stan, as we go into the bedroom where Jean is propped up on four pillows. She’s breathing quickly, her cheeks flushed and her lips pursed, with the rapt expression you sometimes see on patients who are riding their discomfort and don’t have room for anything else.
‘Hello, Jean!’ I say, waving. ‘Shall we sit you up a bit? It’ll help with your breathing.’
Once she’s more upright her breathing does ease a little, and her oxygen levels are surprisingly good. Despite her wasted condition, she still manages to tease me. Stan sits in the wicker chair beside the bed, and starts kneading his hands again.

‘I’ll need to make a quick call to the palliative team,’ I say to them. ‘Is that okay?’
Jean squeezes my hand.
‘You do what you have to do,’ says Stan.
I step away from the bed to make room for him, then make the call standing at the bottom of the bed, using the duvet as a desk for the open folder, which Jean moves with a cheeky nudge of her foot.

Luckily, Sandy answers the phone. Sandy’s a palliative nurse I’ve never met in real life but who always exudes great competence and compassion.
‘We’ll send a nurse out in an hour,’ she says. ‘Meanwhile, have a scootch around and see what you can do in the way of equipment. And start the care as soon as you can.’

‘I think you’ll really feel the benefit of a hospital bed,’ I tell Jean, putting the phone back in my pocket. ‘They’re fantastic, these beds. You can adjust the height, sit the back up – all sorts. All at the touch of a button. The pressure mattress is nice and comfortable, and means you’ll be less likely to get a pressure sore. We can get it installed pretty quick. All we need to decide is where it goes. We’ll need to clear space for it.’
‘I’ll show you the second bedroom,’ says Stan. He gives Jean a kiss then takes me next door.

The second bedroom is half the size of the first, with a single bed in the centre, a wardrobe in the corner and not much else. I’d guess it was the room Stan’s been sleeping in, although you’d hardly know it. There’s a shirt, a pair of trousers, a pair of pants and a pair of socks neatly laid out on the bed, side by side. They look exactly like the clothes he’s got on already.
‘This is great!’ I say, looking around, but not moving. ‘Plenty of room for the hospital bed once this one’s gone. A nice view of the garden. Lovely! What do you think you’ll do with this bed?’
‘I’ll just stand it on its end in the corner by the wardrobe. Maybe throw a sheet over it.’
‘Do you want a hand to do it?’
‘Me? No,’ he says. ‘That’s one thing I’m still good for.’
And we both stand there, side by side, staring at the clothes on the bed, like we fully expect them to magically jump up, throw themselves together and start flying round the room.
‘I’ll make the order,’ I say.
‘Stanley?’ cries Jean.
‘Yes, love…’ he says, and hurries back.

read my lips

Mr Blatchford is a double-up for two reasons. The first is manual-handling: he’s a bed-bound, double-amputee, so he needs two people to log-roll in situ for personal care and wound dressing, and for repositioning in the bed. The other reason is he’s aggressive.
‘It sounds like a suit of armour job,’ says Rosa, the coordinator today. ‘Long sleeved gown, mask and visor, gloves of course. Shoe covers, probably.’
‘Because he’s aggressive?’
‘No. Because he spits.’
‘Spits?’
‘Yes. Spits. Intentionally. Not just when he’s talking.’
‘Has he got dementia or something?’
‘No. He’s just spitty. And sweary. Sorry.’
‘You’re not selling him.’
‘I’m not, am I? Still – he shouldn’t be with us long.’
‘Let’s hope not.’
‘You’ll have to double-up with his usual carer, Mandy this morning. When she’s not there we’ll have to find another pair of hands.’

I know the block well – a warden-controlled place on the outskirts of town. The kind of prefabricated, glass and red-brick building you could throw up in an afternoon if you knew your way round a box of Lego. Mandy meets me at the front door. She seems thoroughly pleasant, which is encouraging.
‘Dickie’s so happy to be home,’ she says, showing me up the main stairs. ‘He’s got all the equipment he needs, so we’re pretty well set-up.’
She gives me a hesitant, backwards glance over her shoulder.
‘What have they … said about him?’
‘They said he was a bit of a handful,’ I tell her. ‘They said he spits.’
She stops on the landing with one hand on the fire door.
‘They’ve said a lot of things about Dickie,’ she says. ‘To be honest with you, I don’t know where it’s come from. I mean – it’s true – he can be plain-spoken. He’s always been a bit fruity with his language. And I think it’s true his mental state has taken a bit of a dip. But this spitting business? I’ve not seen it. Treat him as you find him, of course, but don’t worry about the spitting too much. I think it might’ve got a bit blown out of proportion.’
‘I’ll still gown-up in the corridor, though, if that’s okay.’
‘You do what you have to,’ she says. ‘I’ll go on in and tell him you’re here.’

Dickie is an elderly guy in the last weeks of his life. He’s lying on his back in a hospital bed, the covers tucked neatly up to his chin. The flesh has fallen away from his nose and cheeks and his grey hair is combed back in gelled lines. A pair of enormous steel-rimmed glasses are balanced on the ridge of his nose which magnify his eyes and – with his mouth half-open – give him the appearance of an ancient fish, unexpectedly landed, salted away in a box.
‘It’s the nurse, Dickie,’ says Mandy, gently laying a hand on the covers. ‘Come to see how you are.’
He moves his lips up and down in an approximate way. Mandy smiles up at me.
‘Dickie has trouble speaking,’ she says. ‘But he does make sense if you concentrate.’
I move closer to the bed and lean over, my apron rustling, my visor fogging up.
‘Hello, Dickie,’ I say, speaking loudly to be heard through everything. ‘My name’s Jim. I’m a nursing assistant. Welcome home!’
He turns his head to look at me, and his mouth waggles.
‘What’s that?’ I say. ‘I can’t quite get it.’
‘He says Can you lip read?’ says Mandy. ‘It’s okay. I’ve known him a long time. I’m quite good at it.’
‘I’ll have a go!’ I say, leaning in a bit closer.
He waggles his mouth again.
‘Nope. Sorry. Can you say it again?’
‘Oh, Dickie…’ says Mandy.
‘Once more…?’ I say, leaning in even more closely, frowning, staring at his mouth. The bottom teeth biting the upper lip and then releasing in a tired flick; the lips dropping into something of an O; the bottom teeth touching the upper lip again, releasing more softly.
‘Oh. Okay. Yep. Got it that time.’
Fuck off.
‘He doesn’t mean it,’ says Mandy. ‘Do you, Dickie?’
Dickie slowly turns his head to look at her, and his gnarly old eyebrows quiver – as best they can – into the up position.

avatar vs aliens

John is sitting cross-legged on the floor playing an Xbox game. On the giant plasma screen in front of him are two weird aliens, standing on a barren planet that’s being bombarded with rocks and space junk. Both aliens are about the same except one’s fluorescent blue and the other green. They look like huge, organic, see-through machines, waving delicate antennae, flexing toothy mouths. Spooky electronic music plays on a loop.

‘Alright?’ says John, glancing up as I come in, then moving his spaceman avatar a little closer to the aliens.

John’s an amiable drunk. His alcohol consumption has moved into that cirrhotic purgatory where he needs a certain quantity just to maintain basic function. Quite how he got to that point – and, crucially, how he’ll get out of it – are questions John will have to work through himself along with the support workers from the substance abuse team. For now, we’ve been referred in to help him with any equipment and therapy that might help.

‘This is my spaceship,’ he says, putting the controller to one side and leaning back against the vast futon behind him. ‘Whaddya think? Double king size. And the good news is – I can just crawl in.’

Crawling is how John gets about, mostly, or a strange, insectivorous variation. His legs are terribly deconditioned, fixed in a lotus position from long years on the floor. He reminds me of a magazine article I read once about an Indian sadhu in Delhi who lived forty years or more with his right arm held straight up in the air to distract him from the luxuries of normal life or something. An act of devotion, anyway.

‘They didn’t know what to do with me in the hospital,’ says John, smiling. ‘They wanted me to stay in bed, but I weren’t having none of it. So I tried to escape. ‘Course – they was all waiting for me in the corridor, the nurses, the security people, all standing there with their arms folded. I said to them Oi Oi! What’ve we got here, then? The Gestapo? But they didn’t wanna know. They just dragged me back to bed. And here we are. I suppose you want to do my blood pressure and all that. I think you’ll find it’s in order.’

I run through the obs, one eye on the sphyg gauge, the other on the weird, winnowy aliens on the screen. It feels like they’re hanging back, waiting for me to finish before they attack again.

I unwrap the cuff and take the steth buds out of my ears.
‘How’m I doin’ then, doc?’ he says.
‘Fine. Your blood pressure’s better than mine.’
He laughs.
‘I like that! Better’n yours!’
Then he nods and narrows his eyes.
‘How old are you?’ he says.
‘Guess,’ I tell him. ‘And be kind.’
‘Hmm,’ he says. ‘It’s difficult behind that mask….’
He looks me up and down, scrunches up his face in a series of exaggerated thinking expressions, then snaps his fingers and points at me.
‘Fifty seven!’ he says.
‘Wow! Dead right. Although … I’m a bit disappointed. People usually say I look younger than my age.’
‘Yeah, well,’ he says. ‘You can’t trust people.’
Then he picks up the Xbox controller, and edges his avatar towards the aliens.