a tough gig

Turns out, Miriam’s down to Assist the Co-ordinator this morning. She waves me over as I pass through the office, scattering good mornings as methodically and benignly as an Amish farmer sowing corn.
‘They’ve put me down to do an early care call as well,’ she says, looking flushed. ‘I mean – I’m good, but I’m not that good. I can’t be in two places at once! Everyone else is full, so it looks like only me or you that can do it. I’m more than happy to go if you want to hold the fort here a couple of hours… just as happy if you want to take the job… totally up to you. What do you think?’

The truth? I don’t need to think, but I make a polite show of it. Assisting the Co-ordinator sounds easy enough but it’s actually a pretty tough gig. It doesn’t matter how resolved you are at the start to be organised and Zen Master about the whole thing, barely half an hour later you’ll find yourself with a mobile clamped to one ear, a landline playing loud psycho-electro on-hold music in the other, three people hovering close by, checking their watches, stress-paddling foot to foot, someone else waving a piece of paper over in the Hub…. and then you’ll sigh, and hang up the landline, take a swig of coffee instead, and find it’s grown a skin.
‘It’s okay. I’ll do it,’ I tell her.
‘Are you sure?’ Miriam says, a desperate look in her eye.
‘Don’t worry. Happy to help.’
I take the details.

It sounds straightforward. Charles is an elderly patient who’s going into respite for a few weeks to give his wife June a break. He needs a care call first thing to help him get ready for collection by ambulance. As soon as I’ve picked up my other jobs for the morning, I ring their number. It goes to voicemail. I leave a message to apologise for the early call, and to say not to worry because I’m on my way and I’ll be there by half past eight at the latest.

It’s a bright, zesty drive out to their address, a neat red-bricked block on the outskirts of town. There’s a truck parked outside. Three workmen are busy putting scaffolding up, making a stunning amount of noise – pneumatic drills, banging, shouting, laughing, a radio on full volume in the cab. The workman at the top of the scaffolding, hanging on by one hand, actually throws back his head and howls. It’s all so loud and violent, even though I press my ear to the intercom I can’t hear what June says. The door clicks regardless. I go in.

The thickly carpeted hallway is so quiet by comparison with the racket outside my ears actually whine. I walk up three flights of stairs, then knock. After a long pause, June opens it. She’s tiny, frail as an old sparrow in a housecoat and slippers, blinking at me with her head slightly to one side whilst still holding on to the door.
‘Can I help you?’ she says.
‘Oh!’ I say. ‘Good morning. I hope I’ve got the right address. I’m Jim, from the Rapid Response team. I’ve come to see Charles.’
She stiffens even more, glances down at my ID badge.
‘To get him ready,’ I say.
‘What do you mean? Get him ready? What for? Who are you again?’
‘Jim. I’m a nursing assistant. From the Rapid Response.’
‘I’m sorry but I think there’s been some mistake.’
‘They asked me to come and help Charles get dressed. Before the ambulance arrives.’
‘I don’t think the ambulance will be coming,’ she says.
‘No. I wouldn’t think so. I’m sorry, but I think you’ve had a wasted journey. Did the nurses not tell you?’
‘What nurses?’
‘The nurses who were with us all last night. When Charles died.’
‘I’m so sorry.’
She stares at me, blinking rapidly.
‘Yes. Well,’ she says.
‘And – how are you – bearing up?’ I say, pathetically.
‘It’s early yet,’ she says. ‘But I’ll be fine. I’m sorry you came all this way.’
‘No, no! I’m sorry to turn up like this. That’s awful. I’ll make sure everyone else knows.’
‘Could you?’ she says. ‘That would be kind. Well – goodbye, then.’
And she quietly closes the door.

Outside the workmen are as furious as before. The one who was howling at the top on my way in is now leaning right out, shouting for a particular clamp.
‘Not the three four, you wingnut! The five n’alf! Ye-es! That one, Rodney! That one! Jesus Christ!’
It gets chucked up to him, and he catches it just as it slows, ready to fall back to earth.
‘Halle-fucken-lujah!’ he says, then swinging round again, gets back to his hammering.

ol’ blue eyes & the bug

‘That’s got to be one of the worst discharges I’ve ever had the displeasure of seeing. I mean – for heaven’s sake! It was tantamount to fly-tipping!’
Rosie is smiling like she always does – an easy, enfolding, wise-woman kind of smile that’s been tested for years in the community and is all the warmer for it – but I can tell even Rosie is shocked.
‘I mean – poor thing’s end stage COPD. Thin as a rake. Can’t stand on her own – certainly not safely. I wouldn’t send her home with a live-in carer, but she’s still only got people going in twice a day. When I went in she wasn’t wearing her nasal specs, so her SATS were non-existent. She was in a right state.’
‘So what did you do?’
‘I sent her straight back in! I know they’re short of beds, but that was ridiculous.’

It’s early evening. The rapid response office is cooler and calmer. The change from the morning is astonishing. Then, every desk space was occupied, the kitchen crowded with people making drinks, people walking backwards and forwards, stopping for urgent briefings, catching-up, gossiping, serious conversations, hilarious conversations, secretive conversations, the whole thing layering and building and rising with the press of the day’s business until it reaches a peak and all you hear is a great massy buzz, the murmuration of a large community health team getting ready to fly out over the city. Now, at the end of the day, the last of us are coming back, handing over, doing admin. It’s quiet. There’s plenty of space. I love it.

‘And that’s not all,’ says Rosie, sitting on the edge of the desk and reaching into her pocket. ‘I brought back a friend…’
She pulls out a clear plastic specimen tube, about as big as your thumb, with a screw-top lid. She holds it in front of her and gives it a little shake. Inside is a bed bug. It’s on its back wiggling its legs in the air, but she taps the tube helpfully, it rights itself, and begins pacing up and down the tube, exploring the confines of its prison.
‘The place was riddled,’ she says. ‘They were supposed to have fumigated it but it obviously didn’t work. You’d think they’d have checked. These things are indestructible.’
She waggles the tube again; the bed bug tenses.
‘I heard they’re a really ancient life form. They were being a pain when the dinosaurs were around. Although they probably weren’t called bed bugs then.’
‘No? Probably Tyrannosaurus Rex bugs.’
‘Bronto bugs.’
‘Jurassic pain in the arse bugs.’

One of the admin workers at the far end of the office has the radio on quietly, which is always a nice touch this time of day. It starts to play the famous intro to that Frank Sinatra song, New York, New York.
Rosie gives the tube another shake and holds it up to her face to have a close look.
‘They’re quite cute, in a horrible kind of way,’ she says. ‘I suppose we’ve all got our roles in life. You have to respect that.’
‘What are you going to do with it?’
‘Oh – I thought I’d probably put him down the toilet. Burial at sea. Poor thing. I’ve got enough pets, though.’
She smiles, and starts singing along with Frank.
I’ll make a brand new start of it, New Yoooork, New Yoooork…
She slips the tube back in her pocket and jumps off the desk.
‘But that’s the way of the world, I guess. Somebody singing New York, New York; somebody getting flushed.’

on all fours

The cottage that Jenny has shared with her mother for thirty years is a narrow, two-storey affair, squashed between its neighbours, a knocked-through living area at ground level, Jenny’s bedroom and a spare room on the first, her mother’s bedroom and the bathroom on the second, the whole thing connected by a staircase as bare and steep as a spinal column. Over the years the two of them have held onto everything that came their way – books, pictures, papers, nick-nacks, cables, lamps, linen, plates, cameras, typewriters, spools of thread, film, whatever – the whole lot either stuffed in carrier bags, strapped in old suitcases or packed in plastic crates, everything piled-up, stuffed-in, balanced-on, walled-up, to the extent that you turn round on the spot looking for somewhere to put your bags, complete a full circle, and end up standing there smiling bravely instead.

‘I’m so sorry about the mess – I’ve been trying to have a bit of a tidy up since mummy became ill – well, I say ill – I should say iller – if that was a word – is that a word? – maybe I just invented a word! – because you know I’m not the full ticket myself – I’m half worn out – you should see me going up those stairs – on all fours half the time – like a goat! – well, not a goat, more like a monkey – a monkey with a bad back – you see, I had a cancer scare – I’m sixty after all – I suppose you’ve got to expect these things – it’s a shock when they happen, though – don’t get me wrong – you know about mummy’s cancer, don’t you? – riddled with it I shouldn’t wonder – but she won’t let them look – she won’t listen to anyone – never has – look at this place! – but if I threw out one little scrap she’d know and have a fit – come in a bit, I need to lock the door behind you – I never know whether lifting the handle on its own is good enough – best not take chances…’

It’s a test of spatial reasoning to figure out how Jenny is to get past me and my three bags of kit without one of us either burying ourselves, or both going outside and coming back in again in reverse order. Meanwhile, Jenny talks constantly through the whole, complex procedure. It strikes me that her conversation is a verbal representation of the house, lacking any kind of editing function, any random thought or memory as good as the next, no clear space, nothing to point. The stress of the situation doesn’t help, of course. It sounds as if their relationship has been pretty difficult over the years. As Jenny’s monologue continues, an image slowly develops behind it, like a Polaroid picture moving from ghostly impression to something more solid, something with colour and depth, a long face, thin lips, guarded expression.
‘Straight up – right to the top – well, I SAY the top….we’re coming mummy!…’
Jenny follows behind, on all fours.

please welcome on stage…

Buddy Holly is sprawled on the back of the sofa, Eddie Cochrane is staring down at me from the top of the wardrobe, and Elvis Presley is lying on the floor with his paws in the air, waiting to be tickled.
‘That’s so Elvis,’ I tell Pat, leaning in.
‘He’s still quite kittenish,’ she says. ‘You wouldn’t think he was twelve.’
Elvis grabs my hand with his front paws and rakes me with his back, but keeps his claws retracted. His mouth gapes, his eyes deepen to perfect circles of black, and his ears flatten.
‘He loves that,’ says Pat.
‘He totally looks like Elvis’ I tell her. ‘Maybe in his cape years.’
‘I thought about making him a cape once,’ she says. ‘But I didn’t want him swallowing the rhinestones. He eats most everything else.’
‘Okay. Enough now, Elvis. What about you, Pat? How are you feeling today?’
‘Oh I’m alright,’ says Pat. ‘I’m always alright. I don’t know what all the fuss is about.’
‘I think it was because you fainted and broke your hip.’
‘Yes but – these things happen.’
‘Do they know why you fainted?’
‘I got up too quickly. Eddie and Buddy were fighting and I had to sort them out. Next thing I knew I was staring up at them, and when I tried to get up my hip was agony.’
‘Did you have a carelink button then?’
‘No! It’s only since. No – I had to crawl to the phone. It was only on the hall table but it may as well have been the moon. Luckily Ian across the way has a key, so the ambulance didn’t have to break the door down.’
‘That’s something anyway.’
‘I was in hospital for ages. It was torture. My poor cats. I was worried sick.’
‘Did Ian look after them?’
‘No. He’s allergic. If he sees a cat on the telly he sneezes. No – they had to go to a cat hotel, out in the country.’
‘Sounds lovely.’
‘It wasn’t. It cost me an arm and a leg. And I don’t know what they spend the money on because it certainly isn’t food. They were half starved when I got them back.’

I can’t imagine any of these cats half-starved. I struggle to imagine how Eddie Cochrane makes it up to the top of the wardrobe without a hoist.

I run through the usual observations, blood pressure, temperature, SATS and the rest. Everything checks out. Pat’s blood pressure drops a little when she stands, but not precipitously, and ever since the accident she knows to do things slowly, in stages.

‘I’m guessing you like rock and roll then,’ I say, taking the pressure cuff off her arm and nodding in the direction of Buddy Holly, who’s sitting staring at me from the kitchen with such a fixed expression on his face I feel unaccountably possessed by the urge to walk over and open a tin.
‘Not particularly,’ says Pat. ‘I got them all as kittens, and they were so funny, I could just see them jumping around on stage, playing guitar.’

a matter of life and death

I know I know Mr E; I just don’t know where from.

‘Shall I come through to the sitting room?’ he says, struggling to rise from the dinner table. ‘Or would you like me to stay here? Actually – d’you know what? – I’d like to come through to the living room if you don’t mind. The light’s better there and we’ll all be more comfortable. How does that sound? Alright? Marvelous! Let’s go!’
If I didn’t know any better I’d go through that whole finger-wagging, face-pulling, Wait a minute… I know you….! charade. But I was with a colleague once when he did exactly that, and it was so excruciating I didn’t know where to look.

I was working for patient transport then. We’d been sent to pick up a patient from a busy London hospital, and we’d met a famous actor coming out of a ward.
Hang on a minute! I know you…. Paul said, wagging his finger. Don’t tell me, don’t tell me….
The actor was incredibly tolerant, given the provocation. He glanced at me, as if to say: And what about you? Are you going to join in with this, too? All I could manage was a sympathetic smile and a blush as fierce as a blast furnace. Who knew what family difficulties the poor man was going through? It was a high dependency ward, after all. His jacket was rumpled, his eyes were red and his hair was flattened on one side, as if he’d been sleeping in one of those high-backed chairs with wings. God knows what was going on.
Paul said a name.
The actor shook his head.
Paul tried another.
The actor shook his head again, absent-mindedly straightening his hair, as if that might help.
‘You’re kidding!’ said Paul.
‘No,’ said the actor. ‘I don’t think so, anyway.’
‘Give me a clue.’
‘I’m afraid you’re on your own with this one.’
‘A cop show? Something about ships? That sitcom…?’
‘I’m sorry’ said the actor, and moved on.
‘Typical,’ said Paul. And then shouted after him: ‘I’ll get it when you’re gone!’
A janitor appeared, and quietly mopped my puddled remains into a bucket.

It’s unsettling, recognising a famous actor. You think you know them – and in a way, of course, you do – but then, fundamentally, you really don’t. It doesn’t matter that you’ve seen their faces in close-up a hundred times, internalised their physical quirks, the idiosyncratic texture of their voice, so that if a mimic reproduced any of these things you’d immediately snap your fingers and say Hey! That’s Mr E! But you don’t know them, and they don’t know you. It has all the intimacy and immediacy of a lucid dream, and like a lucid dream, it vanishes the moment you open your eyes in the real world, leaving you feeling wrong-footed, and strangely older.

We chat as I dress his leg.
‘What line of work were you in before you retired?’ I say.
‘I was an actor,’ he says.
‘I thought so!’
I tell him the films and shows I liked him in.
‘Thank you,’ he says. ‘That’s nice to hear! Actors! We’re a funny old bunch! It doesn’t matter how old we get or how sick, we still need to be told we’re liked!’
‘It must be odd, being on show all the time.’
‘It can make one a little self-conscious. You know, I remember working with David Niven once. You’ve heard of David Niven, haven’t you?’
‘I saw him in A Matter of Life and Death. He was really good in that.’
‘He was, wasn’t he? Well – there he was, David Niven, the world famous actor, and I was right alongside him. At that time poor David was pretty sick, coming to the end of his life, actually. And something he said struck me at the time. We were working on a little scene, and afterwards he said to me he was worried because he thought the director didn’t like him. “Of course he likes you, David,” I said. “He loves you. We all do.” “Well, why does he keep glancing down to the side when we’re doing the scene, then? It’s like he can’t bear to look at me.” And I’m sorry to say but I laughed. “David” I said, “You’ve got it all wrong! He’s just checking the monitor, to see how the shot’s being framed.” So, you see – here was one of the world’s most famous actors, who’d won all kinds of honours, who’d won an Oscar, for goodness sake, written marvelous books, a man who’d had the most glorious career, coming to the end of his life, and yet he was STILL worried what some penny-halfpenny director thought of him.’
‘That’s amazing!’ I said. ‘It must be a funny profession. You’ve got to be sensitive enough to portray a character, but thick-skinned enough to take all the rest of it.’
‘Oh – it’s not so bad!’ says Mr E. ‘I can’t complain. Now tell me – how’s the old leg looking?’
‘All done! How does it feel?’
‘Like a million dollars!’ he says. ‘I’d give you a standing ovation, only…’
And he makes a gesture I’ve seen him make many times before, only – actually – this is the first time I’ve ever seen him do it.
‘Great!’ I say, tidying up. ‘I’d sign it, only…’

my monk

I tell Aleksy I’ve applied for another job.
‘What job?’ he says.
‘Kind of a counsellor. Using CBT. It comes with a year’s post-grad training, so it’d be an amazing opportunity. There’s no way I could afford to do it privately.’
He frowns at me steadily.
‘You want to do this job?’
‘Yeah. I think so.’
‘Isn’t it a bit – how do you call it? – conceited?’
‘How d’you mean, conceited?’
He puts his head on one side, spreads his hands.
‘You have problem. You come to me with this problem. I tell you how to solve problem. Because I know best.’
‘Maybe. I suppose it’s more that you learn some techniques to help the patient break out of unhelpful thought patterns. That’s the idea, anyway. You work on finding a solution to the problem together.’
‘Hmmm,’ says Aleksy. ‘I’m not so sure.’
‘It’s not for everyone.’
‘No. That’s true. You know – one time – a long time ago now – I was feeling a bit difficult, y’know? So I went to this counsellor. And we sat around in chairs talking. Or at least, I did a lot of talking. Until I thought – what am I doing? Coming here to this place, talking to complete stranger, someone I don’t even know? So I stop going, and I sort problem out myself.’
‘Fair enough. Like I say, it’s not for everyone. It’s just one way of addressing a mental health issue. There are others.’
‘I went to monastery,’ says Aleksy.
‘Did you? Wow! A monastery!’
‘Why you say wow? What so wow about monastery?’
‘Nothing – it’s just – it sounds great.’
He shrugs.
‘Well. It wasn’t like I was there for years. Just one month. I spent long hours going into my head.’
‘Yes. Meditation. Because there was this lot of noise in my head. It took long time to clean it all out.’
‘I’ve been using a meditation app.’
‘An app? What app?’
‘Headspace. You get these guided meditations.’
‘And you do this every day?’
‘Every day. For ten minutes.’
‘Is not enough. Ten minutes is not enough. When do you find the time?’
‘In the lunch break. I put my sunglasses on and sit in the car. People think I’m just zoning out listening to music.’
‘Is not enough. Ten minutes wouldn’t even begin to do it for me.’
‘You can do longer. I just always seem to stick at ten.’
‘I have so much noise in there,’ he says, winding his hand in the space above his head. ‘There is such a lot of fuss. Ten minutes wouldn’t do anything.’
‘Maybe I’ll try longer.’
‘You could join monastery like me.’
‘I’d love to.’
And it’s true. I would.
I can imagine Aleksy as a monk. With his shaven head, steady gaze, deliberate movements, his economy of being. I can imagine the monastery, high in the mountains. Attacked by warriors in the moonlight. Aleksy deflecting spears with balletic moves, bodies falling like leaves from the cell window. Aleksy calmly putting on a cloak, wandering the desert in search of justice.
‘Send me the link,’ I say.

how I met my wife

Parkinson’s disease has robbed Alan of facial expression, but from his sparkling eyes I can tell he’s very keen to tell me how he met his wife. Her pictures are everywhere in the flat, a studio portrait of a young woman leaning forwards in a serious, three-quarter pose; shots of her in a wedding dress; cuddling babies; making a speech; holding a hat on her head on the deck of a boat – all with a kind of Doris Day glow, and vastly outnumbering the various other family photos dotted about the place.
‘She died ten years ago,’ he says. ‘I just want to be with her now. Not in a creepy way. It’s just how it is.’
‘I can understand that.’
‘Do you want to know how we met? It’s a funny story. Have you time?’
I tell him I definitely want to hear it, but can he sit down first. ‘Because honestly, Alan – if I hadn’t been standing here with my wicket keeper’s mitts on you would’ve pitched head first into the bookcase. I can fetch whatever you need. Come on! Let me help you to a chair.’
‘Just a sec,now – just a sec,’ he says, turning stiffly on the spot and almost plunging backwards into a pile of records.
‘Whoa! Look – why not have a seat here? I’ll make you a drink and then we can talk about what to do next. And you can tell me how you met your wife.’
He seems to accept this, but instead of heading for the nearest sofa, leads me across the cluttered flat to a dangerously low Ottoman.
‘This’ll do,’ he says, shuffling carefully into position, and then, whilst he’s still miles away, unexpectedly launches himself backwards stiff as a puppet whose strings have been snatched up to throw it back in the trunk. He catches me off guard. I grab the front of his shirt to stop him whacking his head on the wall. The shirt makes an impressive ripping noise.
‘Sorry Alan!’
‘Don’t worry! Don’t worry!’ he says. ‘It’s a cheap old thing. I’ve got hundreds. I’ll just go fetch another…’
He starts trying to get up again. It’s a job to stop him.

* * *

What with one thing and another, Alan needs to go to hospital. Whilst we sit together waiting for the ambulance, he finally gets round to telling me the anecdote about his wife.

‘You wouldn’t think to look at me now, but back then I wasn’t entirely hopeless. I was studying architecture at university. A good friend of mine was doing medicine. C’mon Alan! he said. There’s a party at the local hospital. All the hot nurses will be there. Well I couldn’t say no to that, could I? Turns out it was a big old psychiatric hospital in the suburbs, which put me off a bit, but – well – hot nurses and all that. So we sneaked inside, and there was a long, long corridor, the kind of corridor you see in your dreams, that goes on forever. And coming down this corridor, floating towards us out of the light, were two of the most gorgeous nurses you’d ever seen in your life. One a redhead, the other blond. And we were both so dumbstruck we couldn’t do or say anything, we just sort of stepped helplessly to the side. Except there was fresh wax on the floor under the radiator, and I was wearing my shoes with the shiny soles. So I went flying arse over apex and ended up kicking the blond one in the rear. Two years later we were married. So whenever anyone asks me, How did you meet your wife? I tell them I was in a psychiatric hospital and I kicked one of the nurses.’