feeling the heat

Anna, the coordinator for the early shift, waves me over.

‘Jim? I’ve got a P2 for you, darlink. Nothing massively urgent but I think if you could go there this morning that would be wonderful. I’ve sent it through to you. See what you make of it. Let me know if you need anything else. Okay, darlink? Perfect. Okay? See you later.’

I’m about to ask her something but the phone starts ringing again. She pulls a face, holds up a finger, answers the phone – and immediately gets drawn into something complex. It’s early in the shift and she’s already quite red in the face. Some of that’s the office. The boilers here seem to have two settings: OFF for the summer, ON for the winter – ON being approximately The Surface Temperature of the Sun. It’s ironic that there are disposable cardboard thermometers pinned up around the place, the kind that we give out to our elderly and at risk patients. All of them are so far in the RED zone the caption advises calling 999. Nothing ever changes. We stew when we come back to the office to catch up on admin and stay out as long as we can.

I touch Anna on the shoulder, nod and smile as if to say don’t worry, I’ve got everything I need, and loosening my collar, head for the door.

*

A P2 faller is a patient who needs to be seen reasonably urgently but a little delay is probably fine. The ambulance  made the referral. They had attended Mrs Davenport that morning for a non-injury fall, and identified a few things they thought we could help with.

She doesn’t answer the phone when I call, which is a little concerning, given the history. There’s a keysafe number on the referral. I decide to go over there on spec, just in case she’s on the floor again.

*

‘Hello? Mrs Davenport? It’s Jim, from the Rapid Response Team.’
Nothing.
I’m standing in a long, bare-boarded hallway that stretches ahead to a steep staircase, and past that, into a kitchen with the faintest spill of light.
‘Helloooo? Mrs Davenport? It’s Jim. From the hospital.’
Nothing.
I decide to go into the kitchen first.

The light is coming from a table lamp, set by a rubbed but comfy-looking armchair. There’s a bottle on the floor by one of the claw-foot legs, and a dirty tumbler on a table to the side. I’d guess from the look of the kitchen it’s the place Mrs Davenport spends most time. There’s a Roberts radio next to the tumbler, its aerial so bent she either fell on it or took a bite when the news was bad. Either way, it’s resolutely off.
‘Mrs Davenport? Hellooooo?’
The place has a hunkered-down feel. Stuff piled in the sink. Curtains drawn.
There’s a door at the back. I knock and open it. A toilet and washbasin, both the worse for wear.
‘Hellooo?’
I retrace my steps and begin opening the doors along the hallway. The first is the old sitting room, completely dark, nothing to suggest that anyone’s been in more recently than 1962. Opening the next door makes me jump, because there are coats hanging from a hook and they swing out a little. The next door is Mrs Davenport’s bedroom.
‘Hello?’
She’s lying in bed, completely covered by a quilt. All I can see – apart from the lump in the quilt – is a spread of lank grey hair on the pillow.
‘Mrs Davenport? Hello. Sorry to bother you. It’s Jim, from the Rapid Response Team.’
‘What?’
A clawed hand pushes the quilt from her face and she glares at me.
‘What do you want?’ she says. It’s like I’ve disturbed a wild creature, an owl or something.
‘I’m so sorry to wake you like this,’ I say. ‘I was asked to come and see you by the ambulance.’
‘The who?’
‘The paramedics. They said they picked you up when you fell this morning.’
She blinks a few times.
‘I did not fall,’ she says. ‘I slipped.’
‘But you didn’t hurt yourself, so that’s a blessing.’
She blinks again. It’s like being photographed.
‘Why would I have hurt myself? I went to sit on the bed. I slipped gently to the floor. That’s it.’
‘But then you couldn’t get up.’
‘So I pushed my button. As I’ve been told to do. The paramedics came. They helped me up.’
She stares at me, a little more awake now.
Who did you say you were?’
I tell her, explaining as simply as I can what the Rapid Response Team is, and how we can help.
‘But I don’t want any help.’
‘That’s fine. We’ve only come round because the paramedics said so.’
‘We?’
‘Well – me. But there are other people on the team, as I say.’
‘I was asleep!’
‘And I’m so sorry to have disturbed you.’
‘I don’t understand why you’re here.’
I take a different tack.
‘Are you feeling unwell?’
‘No! Why would I?’
‘Are you in pain? Is there anything troubling you at the moment?’
She stares at me for a very long time, then hooks the quilt back even further so she can get a better look.
‘Yes,’ she says, eventually.

Janet the dog walker

Millie’s poodle Rosie bounds off the sofa when I come in. She lies with her paws either side of a well-chewed rubber Bugs Bunny, glancing down at it, then up to me, then down to the rabbit again, daring me to take it. I can’t decide who has the maddest expression: the rabbit or the dog.
‘I think… she thought… you were Janet,’ says Millie. ‘Janet… the dog walker.’

Millie furniture-walks to a seat at the dining room table. COPD has blasted her body, robbing her of any spare flesh. It’s left her tentative and frail, spindle-thin as a giant crane fly, fumbling for purchase, somewhere to land and catch her breath and think about the day.
‘I don’t want much,’ she wheezes. ‘I’ve got… the medication I need… plus a little something… for anxiety. What I really need… is someone… to come in now and again… to help me… with a bath. That’s all. Do my back… y’know?… the awkward bits.’
The doorbell rings and a breezy woman swathed in waterproofs stamps into the kitchen. I’m guessing it’s Janet.
‘Hiya Millie!’ she says. ‘Phew! It’s bad out there. Oh! You’ve got company!’
I introduce myself, get up to shake her hand which is ice cold.
‘You need gloves’ I say.
‘I need a lot of things,’ she says, pulling out a hankie and blowing her nose so loudly I take an involuntary step backwards. ‘I need to win the lottery,’ she says.
Meanwhile, Rosie has ditched the rabbit and dashed through to greet her. Janet kneels on the kitchen floor with her arms wide. Rosie puts her paws on the woman’s knees so she can reach up and lick her face.
‘You silly girl!’ she says. ‘I’ve had a wash today. I don’t need another one. Do I? Hey?’
‘Will… she be… alright?’ says Millie. ‘It looks… pretty bad out there.’
‘Of course!’ says the woman, grasping the kitchen counter, struggling to get up again. ‘Oof!’
She looks at me.
‘Got any spare knees in your bag?’
‘I’ll have a look.’
‘Good boy.’
She reaches into her pocket for a treat, and for a moment I think she’s going to throw it to me. But Rosie sits excitedly at her feet, and Janet hands it down to her instead.
‘She’ll be fine,’ the woman says. ‘It’s so windy out, I’m thinking of tying some string round her legs and flying her like a kite.’
Millie gives her a panicked look.
‘Seriously, though, we’ll just go for a short one round the park,’ says Janet, giving me such an exaggerated, lop-sided wink I’m guessing her face is still numb from the cold.

smile and act normal

‘You wouldn’t think it, but I’m seventy myself.’
Sam’s right, of course. With her metallic white hair cut jaggedly short and swept back in spikes, her sharp shirt, skinny jeans and fluorescent trainers, I’d have put her at fifty, tops.
‘My knees are worn out. Every few weeks I have to have a needle in my eye because of the macular degeneration. Which means I can’t drive. So I have to take the bus over here every day. And you know what buses are like. It takes me the best part of an hour there and back, twice a day. On top of that I’ve been living in the hospital most nights ‘cos my son in law had an accident and my daughter’s not coping. Plus my own life to sort out. Which needs a LOT of sorting out, these days.’
She takes a breath, staring off into the bright fall of afternoon sun through the window. ‘And I’ll tell you something else,’ she says, trailing off. ‘I’ll tell you something…’
Her chin begins to tremble and she has to turn away.
‘Sorry,’ she says, pulling a tissue from her pocket. ‘Sorry about this.’
‘That’s okay. I can see it’s hard.’
‘Hard!’ she says, with a bitter laugh. ‘Childbirth was hard. Divorce was hard. This is bloody impossible!’
She blows her nose and bins the tissue. Gives her head a little shake.
‘There!’ she says. ‘Now. Good. Where were we?’

We talk through the situation. How her mum Avril is ninety-eight, increasingly frail and forgetful, not eating or drinking, falling more often but refusing to accept any of the practical changes that might improve her situation. She went into hospital for a few days after the last fall. Being discharged today and expected home by ambulance any minute. Although there’ve been a lot of false starts and mix-ups as far as THAT goes. Anyway – Sam is the main carer for her mother, with a little private top-up help from a family friend. Sam has Power of Attorney, thank goodness, which is something, a small victory. But so far it hasn’t helped all that much in practice. Avril refuses to talk about residential care, even for respite, whether for her benefit or – more significantly – for Sam. Things have been staggering on like this for a while. It’s not getting any easier.
‘She was always bloody minded,’ says Sam. ‘I suppose it’s how she’s lived to such a ripe old age. It’s probably what’s kept her going all these years. I mean – It’s not like she’s any different now she’s old. In some ways I think she’s actually more of herself than she was. Which sounds odd, but you know what I mean. Do you?’
I nod and say I think I do.
‘Some things have changed, of course. She repeats herself a lot. Over and over. If I hear that story one more time of her in the air raid shelter with the GI and the rabbits I’ll scream. But essentially she’s still Mum. Which is what makes it so hard. Don’t get me wrong. I love my mum and I’d do anything for her.’
Sam laughs again.
‘Like get the bus twice a day! Anyway – enough of my moaning. Let me show you how I’ve organised her laundry…’
‘Okay.’

I follow her into the hallway. She opens an airing cupboard where a water heater is surrounded by shelves of slacks and vests, everything ironed, neatly stacked and lined up, orderly piles of pants and socks, a clutch of enormous bras hanging down from the top shelf like outlandish nests.
‘What d’you think?’ she says.
‘Wow!’ I say. ‘Pretty organised. You do an amazing job.’
‘You know what? I think I do,’ she says, giving the clothes a long, proprietary look, then slowly closing the door.
The buzzer goes. She stiffens.
‘That’ll be mum,’ she says. ‘Smile and act normal.’

anna, landed

If this happened in a dream – and with the amount of opiate medication Anna is taking, I’m guessing most things must seem fuzzy and dream-like – it would no doubt happen like this: Anna drifts down from the sky in a semi-recumbent position, her eyes closed, her hands folded on her tummy. The roof of the house shivers, becomes transparent and loose, moves apart. Anna drifts down through the Anna-shaped gap, down through through the attic, the upper bedroom, the floor, the fixtures, the criss-crossing joists, the cobwebbed bricks, the insulating wool. Down through the cloying air of the living room, to settle finally on the soft brown sofa. And the ceiling heals up, the roof and everything else. And the cushions roll over like squashy boulders and mould themselves around her. And she’s there, back from the hospital, thoroughly landed. And she opens her eyes as her daughter Christine wanders in to see her, a jug of iced water and a glass tinkling gently on the tray.
‘Did you put in a pinch of vitamins?’ says Anna, grunting as she pushes herself into a more upright position.
‘Yes.’
‘A pinch? Not a spoonful?’
‘A pinch. Yes.’
‘Last time it tasted like a spoonful.’
‘I don’t think so.’
‘Well it did to me.’
Christine shrugs and goes back out to the kitchen where she carries on talking to her friend in an urgent kind of tone.
‘She’s a good girl,’ says Anna. ‘I don’t know what I’d do without her.’

I finish writing up my notes and then put the folder to one side.
‘The thing about back pain – the advice they give these days – is to keep moving.’
She snorts.
‘That’s easy for you to say. You’re not the one in agony.’
‘I know it’s difficult, Anna, but the longer you stay on the sofa the harder it’ll get. You’ll become deconditioned. You’ll be at risk of getting pressure sores.’
‘I know my own body.’
‘Absolutely. But I think there are some practical things you could do to make things easier for yourself. To give yourself the best chance of recovery.’
‘Such as?’
‘Sleeping in bed, for a start. You’d be flatter at night, which is better for you. It’s higher off the ground for getting in and out. And with a bit of re-organisation, you’d have more chance of getting mobile again.’
‘Where do you suggest I put everything?’
I look around. The house is packed full with ornaments and hangings, boxes on top of tables on top of bigger boxes, every bookshelf crammed with books, even the windowsills piled up with stuff. The only free space is the giant plasma TV screen on the wall facing the sofa. Anna turned it off when I came in, and now it hangs there, a window onto a darker, clearer world.
‘It’s difficult, I know, but not impossible. All you need is a decent amount of space for you to get about. As things stand, you’re much too restricted. How do you even swing your legs over to go to the loo?’
She closes her eyes.
‘I manage,’ she says.
‘I’ll ask the physio to come and see you, but I know that’s the first thing they’ll say.’
‘I’ll think about it,’ she says, then reaches to the side for a glass of vitamised water. ‘In the meantime – please speak to the doctor about my pills. Because nothing’s working and I’m in absolute agony.’
‘Of course,’ I say, picking up my bag to go. ‘I’ll pass on the message.’

the cat knows everything

Gary’s shown hostility to health care professionals in the past, and the record says we’re only to visit in pairs. I’m a little early meeting up with Lisa, so I park up outside and take the opportunity to finish off some notes on the laptop. I’ve just settled in to start writing when Gary’s door opens and a woman steps out. She’s tall and pale and pinched looking, wearing a green and black nylon tracksuit, her long hair dragged back in a ponytail. She takes out a fag packet and is just about to have a smoke when she sees me, sitting there. I wind down the window to tell her I’ve come to see Gary and I’m just waiting on my colleague, but before I can say anything she shoves the fags back in her pocket, walks backwards into the doorway, and maintaining eye contact for as long as she can, slowly shuts the door.

It doesn’t augur well.

Lisa turns up ten minutes later. I’d trust any of the team to go on a difficult visit, but if I had to choose, Lisa would be it. The Italians have a word for how she is: sprezzatura – a kind of nonchalance or ease, wearing her skill lightly, with great warmth and humanity, as if it’s really nothing and no trouble at all, and what was it that needed doing, now, and suddenly it’s done, and everyone feels better.

‘How’s it going there, Jim?’ she says, padding along the street. ‘Have you been waitin’ long?’

We go together through the terrible little garden, knock and wait. There are sounds from inside. An exchange of light and shadow in the frosted panes above the door. A clattering of the lock, and suddenly the door opens.
A bare chested man, his eyes squeezed shut, his smile as wide and flat as the Man in the Moon.
‘I expect you’re wondering why I’m half naked?’ he says. ‘Only I was just having a carton of cherry and raspberry squash, and I didn’t want to get any on my t-shirt.’
‘No. That would stain, right enough,’ says Lisa.
‘Yes,’ he says. ‘You’d never get it out.’

There’s a steep, bare board staircase just behind the man. The woman I saw earlier is crouched at the top, peering down at us on all fours.
‘Don’t listen to him!’ she shouts. ‘He sees ghosts!’
‘Okay, now! That’s interesting!’ says Lisa. ‘So… is yer man through in this room, or … ‘
‘Ye-es,’ says the man, stepping to one side and knocking on the door. ‘I say Gary? There are two lovely nurses to see you.’
Show them in but keep Jackie out.
‘Righto.’

The man pushes the door open and nods for us to go through. Meanwhile, Jackie has started coming down the stairs, slowly feeling with her feet for each tread whilst her face stays as fixed on us as a steadicam.
‘Now, now, Jacqueline!’ says the man. ‘Gary doesn’t want you there.’
Jackie gives a petulant scream, sits down on the step and folds her arms.
‘After you,’ says the man.
We step into the room.

It’s hot as a sauna – the foetid, barrelling kind, where you fling urine on the coals instead of water. I wonder how long Gary’s been lying on his bed like this, his teeth grey and claggy as if he’s been snacking on ash. It’s like we’ve stumbled into a mausoleum, where the occupant took up early residency for want of anything better to do, and his stuff got chucked in after him. There are two posters on the wall: Jimi Hendricks leaning back from a guitar solo; The Beatles all in a line.
‘Wha’d’ya want?’ says Gary.
‘Hello there!’ says Lisa, offering him her hand. ‘Nice to meet you, Gary. This is my colleague Jim. We’ve been asked to come see how you’re doing.’
‘How’m I doing?’ he says. ‘I’m NOT doing.’
‘What’s troubling you today, then, Gary?’
‘I can’t keep nothin’ down. I feel sick all the time. I’ve got no energy. I’m wracked with pain. Is that enough for you?’
‘That’s enough for anyone,’ she says. ‘You poor thing. Let’s see what’s what, then. I’ll just do your blood pressure and whatnot and see how that is, and Jim here’ll take a wee bit o’blood, if that’s okay?’
‘I don’t care,’ he says. ‘You may as well. I’ve got to go to the toilet first, though.’
He nods in the direction of a commode whose pot has been removed so it can fit over a bucket.
‘Do you need a hand getting out of bed, there, Gary?’ says Lisa.
‘I’ll be alright, thanks,’ he says. ‘If you wouldn’t mind stepping outside for a bit.’
‘No worries.’
We leave him to it.

Out in the hall the bare chested man has gone and Jackie is nowhere to be seen. Instead, an ancient black and white cat yowls as it approaches us from the living room. I’m guessing it’s blind because both its eyes are white. It feels its way along the wall, one paw at a time. I crouch down and hold my hand out. The cat stops, sniffs the air, then moves in my direction. When it gets closer I see that its tongue pokes out to the side, too.
‘Poor wee fella!’ says Lisa.
I stroke the cat. It starts purring – a deep, rumbly sound – his tail pointing straight up, as if he’s absorbing the affection and transmitting it somewhere.
‘The cat! The cat knows everything!’ says a voice at the top of the stairs.
Jackie is there, staring down at us again.
‘Oh – they do, though, don’t they?’ says Lisa, smiling up at her. ‘Cats. You’re right there, Jackie. They certainly do.’

two from the queue

Maybe in the future they’ll have an AI coordinator. Something with a wipe-clean face and a decent range of expressions. Something that can reply to an email, accept a referral, schedule a visit, settle an argument, make a clinical decision, take a note, make an amendment, triage a patient, liaise with a pharmacist, sort out an IT problem and laugh sympathetically at the struggles of a new member of staff – whilst at the same time keeping tabs on the thirty or so patient visits that are happening at any given moment. Until they do, though, they’re stuck with us.

Coordinating makes you crazy. Uncoordinated. Or, if not that, exactly, more hyper-coordinated, so that everything you do, even the little things, are done so intensely and with such purpose, you feel a little shaky by lunchtime – something which all the coffee you drink does nothing to ease.

You’re besieged by nurses and therapists, managers and carers, cleaners and admin staff, a constant coming and going, everyone wanting something, from a shift swap to an update to a pencil sharpener. I’m so conscious of the noise levels I’ve toyed with the idea of wearing a Daft Punk-style helmet – maybe with a light on the top that’ll flash when I’m available. I feel sorry for whoever it is I happen to be speaking to on the phone. They must think I’m calling from a bus station or a call centre. It can’t sound good.

There are some perks, though. Limitless coffee is one. The buzz of getting things in order is another. But one of the best are the random conversations you overhear when people are waiting to handover.

For example:

A: I went on that dating app you told me about.
B: Yeah? How d’you get on?
A: Alright. I struggled a bit with my profile. I thought I sounded a bit boring, so when it said hobbies I put chess.
B: Chess?
A: Yeah. Why?
B: Can you even play chess?
A: No.
B: Aren’t you worried you’ll get found out?
A: We’re hardly likely to be playing chess on our first date, are we? Unless they’re a complete perv.
B: But what if they ask you about it?
A: I’ll just say I like to play it now and again and that’s it.
B: But what if they ask you stuff?
A: Like what?
B: I don’t know. Who your favourite player is.
A: (laughs) They won’t.
(pause)
B: Don’t you think it might put them off?
A: I’ve already had two dates.
B: Two?
A: Two.
(pause)
B: They must be desperate.
A: Thanks a lot.

And another:

A: I was at the doctor’s the other day and there’s this kid with his hoodie up standing in front of me in the queue, shuffling about. And I think to myself – hang on a minute, that’s Tiffany’s youngest, Brandon. So I tap him on the shoulder, and he turns round, and fuck me, it was! So I says to him “What are you doing here, Brandon?” – but then I think – No! Noooo no no! That’s naughty. I can’t be asking him that. I mean, he might go and tell me, and that’d be awkward. For both of us. I mean – I’m best mates with Tiffany and I might struggle not to spill the beans. But do you know what he says? He says “I’m too embarrassed”. So I say “Well you gotta tell me now.” And he goes: “No. You’ll just think I’m a dullard.”
B: A dullard?
A: A dullard. That’s what he says. A dullard. I didn’t even know what it meant. I thought it was a kind of duck.
B: What teenage boy uses a word like dullard?
A: A Brandon-type boy, obviously Shell. Anyway, I say to him: “Whatever it is I won’t think any the worse of you. Promise.” So he says: ‘I’ve got a fingernail stuck in my throat”.
B: A fingernail?
A: He bites his nails and swallows it. And a bit got stuck in his throat.
B: Urgh! Who bites their nails and swallows it? Gack!
A: Yeah? Well – sorry to ruin your world, Shell, but a lot of people do. And not everyone who picks their nose flicks it, neither.

a ghost called alf

I’m looking through Judy’s notes, the last time someone listened to her chest. I can’t help laughing.
‘What’s so funny?’ she says.
‘Well – I think the nurse who wrote this must’ve been hungry. She’s written bilateral crepes.’
I show her the little drawing in the notes. The rough sketch of her lungs, a line of little crosses at the bottom of both, an arrow pointing to them.
Judy’s expression doesn’t change.
‘What does that mean?’ she says.
‘It should say creps.’
‘Craps?’
‘Creps. Short for crepitations. I think that’s what it stands for. Anyway, it’s that crackly sound you get sometimes when there’s gunk in the lungs.’
Judy shrugs.
‘I know all about that,’ she says. ‘I’ve had enough of that.’
‘You’re sounding better today, though.’
‘I’m not dead yet, then?’
‘No! Alive and kicking.’
‘I’ll kick you in a minute.’
‘I wouldn’t mind.’
She stares at me.
‘Where are you from?’ she says. ‘Or-stralia?’
‘Australia? No! I was born in London but brought up in the Fens.’
‘Oh,’ she says. ‘That explains it.’
I shut the folder and carry on with the examination.

Judy is ninety-eight but looks older. In fact, with her quilted housecoat, netted, silvery hair, enormous slippers, stiffly jointed movements – the way she wobbles along clinging to a kitchen trolley loaded with toast, Tommy Tippee beaker and emergency button – it feels like I’m in a marionette update of the Red Riding Hood story, where the Big Bad Wolf works for a Community Health Team, and lets himself in with the keysafe.

‘Are you going to be much longer?’ she says.
‘No. Almost done.’
She takes a toot of tea from the beaker.
‘Would you like me to freshen that up for you?’
‘No – thank you,’ she says. ‘I shall need the lavatory.’
There’s a pause whilst I add my notes to the folder.
‘What did you do – before you retired?’ I say.
‘Shorthand typist,’ she says.
‘How lovely!’ I say. ‘I like typing. It’s one of the most useful skills I ever learned. That and driving.’
‘I worked in a brewery,’ she says, moving on. ‘That’s where I met Alf.’
‘Did he work in the office, too?’
‘Nah. He was in and out. But we’d throw things at each other and we sort of went on from there.’
‘Sounds brilliant.’
‘It was hard during the war, though. Terrible hard. There were these Ack Ack guns on the roof. You should’ve heard ‘em when they went off. Boom! Boom! Boom! The whole place shook like it was gonna fall in. They were having a pop at all them German bombers comin’ over. It was a terrible business. Terrible.’
‘How long were you married, Judy?’
‘A long time. So long I couldn’t tell ya. But Alf’s been gone for years now and – well – that’s that.’
‘I’m sorry.’
‘What for? It’s not your fault. Is it?’
‘No. I suppose not.’
‘Well then.’

I put the finishing touches to the notes.

‘Why don’t you go upstairs and have a lie-down if you’re tired?’ she says.
I look up from the folder.
‘Sorry, Judy – what?’
‘Not you,’ she says. ‘Him.’
She narrows her eyes and nods at the empty chair behind me. I turn to look.
‘My old man,’ she says, sighing and leaning back again. ‘If I don’t keep talking to him he might go orf’ with someone else.’