prawn’s gambit

Gerry is on the floor when we arrive to do the assessment. He’d been there all night, and although he hasn’t hurt himself, he’s in pretty poor shape. We clean him up as best we can, then call an ambulance to take him to hospital. There’ll be a two hour wait, the call taker says. Exceptionally high demand. Like it’s ever any different.

In the meantime we try different ways to get Gerry off the floor, positioning chairs, encouraging him to roll over into an all-fours position that he might be able to progress into a kneel then a stand. But although he tries his best he’s just too weak; the chronic pain in his arm from a recent fracture means he’s got limited upper body strength to call on, and his legs won’t support him even if we physically boosted him up. In the end we admit defeat, and decide the best we can do is surround him with cushions and pillows, ply him with water and biscuits, and wait for the paramedics.

My colleague has to go to another call; I settle down on a kitchen chair to wait with Gerry.

Gerry has been smoking forty a day for the best part of thirty years, with the result that the whole flat – from the curtains to the carpets, the doors to the clock on the wall – is coated with a grungy patina of nicotine. It’s a hot day, so I open the windows for some fresh air. Even the flies that blunder in haul on the brakes and head straight back out again.

‘How long have you lived here, Gerry?’ I ask him, sitting back down on the chair.
‘Ooh – a long, long while. When they were built, pretty much.’
And it’s no doubt a consequence of sitting here with him for so long, but I imagine the builders laying the first course of bricks around us, Gerry on the floor, me on my chair, Gerry thoughtfully stroking his enormous Father Christmas beard, me checking my fob watch.

There’s a bookcase just behind him, filled with books on chess.
‘You like chess, then?’ I say, artlessly.
‘Oh yes!’ he says. ‘Yes, yes!’
‘When did you learn?’
‘When I was at Grammar school. I saw some kids playing and I thought hmm – what’s that? So I got a book out of the library. Then another book. Then another one. And I gradually taught myself all there was to know. I played in local leagues, bigger competitions. I was never international, but I got pretty good.’
‘I know how to play,’ I say. ‘Basic stuff. I don’t have any tactics, any strategies. You know? The prawn’s gambit and all that?’
‘Prawn’s gambit?’
‘I just made it up.’
‘Hmm – the prawn’s gambit,’ he says, stroking his beard. ‘You might have something…’
‘My problem is I just throw everything forward and hope for the best.’
‘Hmm,’ he says. ‘Yes.’
‘I don’t know who even invented chess. I know it’s pretty old. I remember seeing the Lewis chess pieces in the British Museum once. They were cute.’
‘There are lots of myths around the invention of it,’ he says. ‘My favourite is the one about the Indian king.’
‘What’s that?’
‘Well you see, a long time ago there was this great king. And he was bored with all the usual games, so he put out a proclamation. Invent a new game and the winner gets as much gold and silver as they desire.’
‘And the losers get killed.’
‘Quite possibly. Anyway, lots of people came forward, but the best was a wise old mathematician who offered the king chess. He told him he’d based it on court life, with soldiers, bishops, knights and so on. The mathematician taught the king how to play, and through playing the King learned his first important lesson, which is that everyone under his command has a role to play, from the most insignificant pawn to the grandest queen. And the king was very struck with this game, and told the mathematician that he’d won, and could help himself to as much gold and silver from the Treasury as he liked. But the mathematician said no thank you – what I’ll have is one grain of wheat on the first square of the chess board, doubled on the second, then again on the third, all the way to the last of the sixty-four squares. And although the king was put out, because he didn’t think a few grains of wheat were a satisfactory prize, he agreed. But of course he soon realised his mistake, because the number of wheat grains grew exponentially, until he owed him more wheat than his kingdom could ever produce. So that was the king’s second lesson – never underestimate the power of mathematics.’
‘Then what happened?’
‘I don’t know. He probably had him killed. Life’s not really like chess, is it?’

canned

There’s a sound like someone managing two sharp turns of a rusty bolt, then a cat walks in – or rather, rocks from side to side, easing its hips.

The cat is ancient, its fur clumpy and all over the place, like someone tossed a tiny black and white throw in the washing machine then slung it over some sticks to dry. The cat’s eyes burn fiercely, fixing it to this life. I imagine if it blinked, the whole thing would simply vanish in one, final, dusty meow, and the little black and white throw would gently settle onto the rug.

‘Twenty three’ says Agnes, pre-empting the obvious question.
‘Wow! Twenty-three! We had a cat that was nineteen and I thought THAT was old. But twenty-three…’
The cat stares at me: Say twenty-three again – I dare you – I double-dare you… I hear in my head.
‘Where did you get him?’
‘The cemetery.’
‘The cemetery?’
‘He was about one they reckon, with his head caught in a can. The fire brigade had to snip it off. It was in the papers. When I read about it I went down to the shelter. He was furious with everyone of course. But I spent some time there, sitting with him, just talking about this and that. And he seemed to come round. And when I asked if I could adopt him they said yes! And here we are!’
‘So what did you call him?’
‘Guess,’ she says.
‘I don’t know. Lucky?’
She shakes her head.
‘Snippy? Beans?’
‘It was a tin of cat food. I don’t suppose he’d have tried so hard if it was an old tin of beans.’
‘No. You’re probably right. I don’t know, then. I give up.’
‘Tintin!’
‘Of course.’
‘Actually I didn’t call him Tintin. The girls at the centre did. But it seemed to stick.’
‘Like the can.’
Agnes doesn’t respond to that; Tintin certainly doesn’t.
‘YOU’RE SITTING IN MY SPOT!’ shouts Agnes suddenly leaning forward. ‘THAT’S WHERE I LIKE TO JUMP UP!’
She sounds so cross I actually flinch. For a second I think she means I’ve inadvertently taken her place on the sofa. But – jump up? The last time Agnes did any jumping up was maybe the Marquee Club in 1962.
‘That’s what Tintin’s thinking,’ she says, relaxing back again. ‘But don’t let him bully you. Now then – where were we…?’

Billy’s nest

I’m waiting for Georgiou, the physiotherapist. It’s a smart street, not at all the place you’d expect to find a hostel like this – not because the effects of alcohol and drugs aren’t universal, but because the rents are so high. Maybe it was some kind of bequest. Fact is, the Georgian terrace houses either side and across the road are as fancy as you’d expect for a street off the main drag of a wealthy seaside resort.

A Mercedes Uber pulls up. A man and a woman dressed immaculately in 1920s costumes hurry out of a door opposite and jump laughing into the back of it. If it wasn’t for the modern car with the decal on the side, I’d be worried I was seeing ghosts. I watch the car pull away, and see Georgiou standing on the other side waiting to cross.
‘Did you see that couple?’ I ask him.
‘What couple?’ he says.

I buzz the intercom and the door clicks open. Inside there’s a tiny, security lobby with nothing in it but another door and a perspex grille to the side. A woman frowns at us through the grille. I hold my pass up, she scrutinises it, then clicks us through the inner door. We walk round to the front of the office, which is a counter with another screen. She’s waiting for us with a ledger and a pen. It’s a confusing interaction; she uses code words and acronyms I’ve never heard before, and gets huffy when I ask what it all means.
‘Just sign here,’ she says, jabbing at the ledger with a biro. ‘And take this…’
She hands me a radio and a bunch of keys.
‘Press to talk,’ she says, holding her own radio up.
‘Yep. Got it!’ I say, waving the radio.
‘No. Press to talk,’ she says, then presses the side button on her radio. ‘Testing, testing…Control to R2, receiving…?’
‘Oh! Right!’ I say. Then I press my button and talk back.
‘R2 receiving, loud and clear. Erm…. Over.’
‘You don’t have to say all that,’ she says, clipping her radio back on her belt. ‘Just talk’

Once I’ve filled out the ledger with our details, the woman tells us that Billy, our patient, lives right at the top of the hostel.
‘It’s a long way up,’ she says. ‘Keep going till you can’t go anymore.’
‘Do we need oxygen?’
‘No. It’s not that high.’
I’m aware of her watching us as we go through the first fire door and start walking up.

‘Billy has breathing problems, discharged after a recent exacerbation, lives at the top!’ says Georgiou, striding ahead of me. ‘Makes perfect sense.’
The stairs go on forever, getting narrower and steeper as we go, first floor, second floor, third, up and up and up, past landings of decreasing size, everything warping and tilting like the house is morphing into a giant tree.
‘Where does this guy live – a nest?’ says Georgiou.
And finally we’re there, standing outside Billy’s room, panting. I lean on the balustrade, which wobbles so alarmingly I immediately stand up straight again.
Georgiou knocks.
‘Hello Billy?’ he says, putting his face close to the door. ‘It’s Georgiou, the physio from the community health team, come to see how you are. With Jim, the nursing assistant. Are you up yet?’
There’s a scuffling noise inside. I’m half expecting a giant squirrel to open the door, and actually I’m not far wrong. Billy is a hunched middle-aged guy, his t-shirt riding up over his belly, huge, dilapidated fur slippers on his feet, a tin of Golden Virginia clutched in his paws in lieu of an acorn. If he ever had a tail, he’d long since taken it off and wrapped it around his head for a beard instead. It seems to twitch as he stares at us.
‘What?’ he says.
‘We’ve come for a physio assessment,’ says Georgiou.
‘What kind of assessment?’
‘We want to see how you are on the stairs.’
‘Me?’ he says. ‘Terrible! There! That was easy! I’ve got the cee oh pee dee whatsit, I’m getting over a chest infection, I drink a bottle of rum a day, so all in all you might say I’m running out of options.’
‘I’m sorry to hear it.’
‘I’m sorry to say it. But what can you do?’
‘I think the first thing would be to get you in a flat nearer the ground.’
‘That’s true. You’re right there. They’re working on that … so they tell me.’
The radio squawks in my hand so violently I almost drop it.
Control to R2! Control to R2! Status update. Over.
I press the button.
‘Yeah. All good, thanks’ I say. Then, as an afterthought: ‘Over’.
Control out.
Billy laughs.
‘You know the best thing about radios, doncha?’
‘What’s that?’
‘The off button. So c’mon then. A stair assessment. Okay. Ready? There’s a fackin’ lot of ‘em. There! Bosh. Done. Thank you very much and goodnight.’

moth orchids

For the life of me, I cannot figure out this gate. It’s held with a strange drop-down mechanism I’ve never seen before, something you have to raise up then angle straight out so the hoop of the gate can pass over it. Something like that.
Brenda watches me from the back door.
‘There!’ I say. ‘Made it!’
‘Well done!’ she says, clapping in that speeded-up way people do with their wrists together. ‘It is fiddly!’
She stares at me so intently, her makeup and hair so perfect, her pink slacks and knitted white cardigan so – I don’t know – central casting, I get the strange feeling I’m in a sitcom. And I’ve forgotten my lines.
‘Come on in!’ says Brenda, improvising to cover. ‘We’re so grateful you stopped by.’
I follow her into the front room. It’s as immaculate as Brenda, of course, with the same, stagey aura of perfection.
‘Shall I fill you in on some background?’ she says, gesturing to a sofa.
‘Sure.’
I put my bags down, and when I sit on the big cream sofa, it’s hard to resist sitting exactly like Brenda, knees together, legs angled off to the left, like a debuttante or something.
‘I’m worried about James,’ she says, massaging the rings on her gnarly fingers.
‘I’m sorry to hear that, Brenda. Why? What’s been going on?’
‘He’s not himself. Six weeks ago we were on the bus together, going off along the coast, having a lovely day out. Having adventures. I mean – he’s never been the chatty sort, but if you ask him a direct question – nose to nose! – he’ll answer you alright!’
When she says ‘nose to nose’ she puts the flat of her hand to the end of her nose, then peeks round it, and smiles.
‘So – six weeks ago, James was his normal self. And now… what’s happened?’
‘Well he’s just become sleepier and sleepier, until this last week he can’t even get out of bed.’
‘Oh?’
‘It’s really not like him. He’s normally so active. I’m so glad you’re here because otherwise I don’t know what I’d do. I’ve got Steven of course, our son, and he’s wonderful. But he’s not a doctor, is he? He’s as worried as me.’
‘Well I’m sorry to hear you’ve had a difficult time of it, Brenda. Shall we go upstairs and say hello to the man himself?’
‘Yes!’ she says, brightening and standing up. ‘We’re both so grateful for the NHS. You’re lifesavers, really you are.’
‘That’s kind of you to say so.’
‘Oh I mean it. I have nothing but admiration for the work you do.’

I follow her up the stairs, past a pot of green and white moth orchids, reaching down towards us from their alcove.

James is lying on his side in bed, his flushed and veiny face quite a contrast with the crisp, white duvet. Brenda walks round to the other side and gives him a tentative shake.
‘Jimmy? Darling? It’s a nurse from the hospital. He wants to see how you are…’
James slowly opens his eyes and stares blankly at me. Then he smiles and mouths the word hello.
He does seem very sleepy, nodding off when I talk to him. And whilst it’s true the room is warm and close, still I’m concerned. I take a set of obs, which surprisingly come back as normal.
‘And six weeks ago you were off together on the bus for a day out?’ I say, feeling his pulse, wondering what on earth is going on with his guy.
‘Yes! He’s always been so fit. I can’t understand it.’
‘Has the doctor actually visited James?’
‘No,’ she says. ‘They rang me up and we had a chat. I don’t know what to make of it at all.’

I phone the lead nurse and we talk through the situation. She agrees that it’s a good idea to take some bloods and see if that sheds some light. Meanwhile, we book in a follow-up nurse visit for later in the day.
‘We’ll be in touch!’ I say, waving to Brenda as I walk back through the front garden, expertly flipping the gate latch. with one hand.
‘Thank you so much!’ she says, then steps back inside, and quietly closes the door.

*

Later that day I talk it over with the nurse who took the follow-up visit.
‘It’s strange,’ she says. ‘He looks really unwell, but I can’t put my finger on it. Brenda says six weeks ago they used to go on the bus along the coast. I couldn’t decide whether his speech was affected or not. Brenda says he’s never been chatty, but if you ask him a direct question nose to nose…’
She makes the same hand gesture that Brenda did when she told me the story, too.
‘Brenda’s known to the memory clinic,’ I say to her.
‘Er-hum,’ says the nurse. ‘But she seems pretty fine for all that.’

*

The bloods are all fine. Nothing at all to indicate any acute illness, nothing to explain his sudden six week decline, increased lethargy and inability to get out of bed.

I try ringing Steven, the son, for some more information, but his phone keeps going to voicemail. In the end I decide to book in some further nursing visits, and to email the GP with a breakdown of what we’ve found, and what we think might need to happen next, including CT head to exclude any acute changes there.

Luckily, I try one last time to call Steven before I send the email.

‘You know mum’s got dementia, right?’ he says.
‘Well … I read she was known to the memory clinic.’
‘Right!’ he says. ‘She’s pretty confused. I know she presents well, but honestly, she’s clueless. The thing is, up till now she’s been the one getting dad out of bed in the morning. Ever since his stroke he’s been much less active. If you left him to it he’d just stay there all day. Once he’s up he’s not too bad, but he needs a lot of encouragement. Mum’s been good up till now, but for some reason these last few weeks she’s not so able. She’s got this idea he’s going to fall and it’ll be her fault, or something. I don’t know. Anyway – I do what I can to help out, but I can’t be there every morning. I’ve got a job and my own family to take care of. So that’s why the GP got you lot involved.’
‘So this story about how six weeks ago they were off on the bus together along the coast…?’
‘Six years, maybe.’
‘And you’re not worried that your dad’s more unwell?’
‘Dad? No! He’s the same. I mean, look – he’s never been what you might call chatty…’

squirrel cam

I can only think Ann was a philosopher or a physicist – or possibly a witch – because as a memorial, Ann’s Court is something of a gigantic, infernal puzzle. The other possibility is that Ann’s Court is built on some kind of ley-line snarl-up, a geo-locational snag that sends people sensitive to those things immediately insane. There has to be some reason I always get lost here, other than simply being tired and a bit dense. Being built into the side of a hill definitely doesn’t help, so that coming in the front door effectively means you’re starting off in the basement.

To be fair, even the people who live here seem to be confused. The sequence of buttons in the lift starts from lower ground. The designer has circled this button with green plastic, which I suppose in some ways suggests GO or WAY OUT. But it’s clearly not enough, because someone has taped a piece of cardboard with EXIT next to it, written in such a shaky hand I’m guessing it took them some while to find it, too. Each floor has about twenty flats, the corridors exactly the same, every front door identical, the numbers running in such a hectic, jumbled up, any-how order delivery people must come here in teams, calling out to each other at intervals, spooling out meters of fluorescent rope behind them, like cave divers.

So it’s something of a miracle that I find Dorothy’s flat.

She’s sitting in a straight-backed chair, hands on either handrest, an occasional table to her side with a plate of biscuits covered with a draped square of kitchen towel. The room is remarkably empty, with just a television, a small table and two chairs, and Dorothy. There’s a white and black plastic globe on the mantelpiece just exactly like a giant cartoon eye, which I’m guessing is a security cam.
‘Hello!’ I say. ‘I’m Jim, from the rapid response team, come to see how you are this evening.’
‘Hello,’ she says, severely. ‘Have you come to give me my pills?’
‘Yes. And anything else you need.’
‘The pills are on the top of the kitchen cabinets above the cooker,’ she says.
‘Okay!’
Dorothy watches me closely as I put my bag down and go into the little galley kitchen. It’s as bleak and empty as the rest of the flat. Above the work surfaces and the cooker are a line of cupboards. The door over the cooker looks like the cover to an extractor fan, so I ignore that and open the cupboards left and right: stacks of plates, a few cups, but no pills.
‘Not there!’ she shouts. ‘Above the cooker!’
There are some packets of pills on the very top of the extractor fan cover, although why someone would put them there I’ve no idea. It’s too high for me to reach, so I come out of the kitchen to fetch a chair.
‘What are you doing?’ she says.
‘I’m not tall enough.’
‘What do you mean, not tall enough?’
‘I need a chair.’
‘No one else needs a chair.’
‘Well – they’re probably taller than me.’
It’s odd, though. Even the tallest in our team would still struggle to reach those pills.
I go back into the kitchen and go up on my tippy toes to illustrate how far out of my reach the top of the cupboard is.
‘But they’re not up there!’ she shouts. ‘They’re in the cupboard!’
‘What – this?’ I say, pulling on the extractor fan cover.
‘Dear God – yes!’
It opens. It’s not an extractor fan cover. It’s a cupboard, with a yellow folder and a blister pack of medication.
‘Oh!’ I say, taking them out.
‘Oh,’ says Dorothy, imitating me. ‘Oh.’
Both Dorothy and the security cam scrutinise me as I check the MAR chart against the pills in the blister pack, tick the relevant boxes and dish them out.
‘I swallow this one and crunch that one,’ she says. ‘With these…’ exposing a set of yellowing teeth and clacking them rapidly.
‘Shall I get you some fresh tea?’
‘No,’ she says. ‘I like it cold.’
She takes her pills.
‘All gone!’ she says, poking out a chalky tongue.

When the visit’s all done and I’ve helped her to bed – the bedroom and the bathroom both with the same, giant eyeball cams – I turn out the lights and leave the flat. The floor lights snap on automatically, a vista of identical doors, identical landscape prints on the walls.

I decide not to use the lift, because it’s only three floors up, I need the exercise, and anyway, because of the pandemic, you shouldn’t use the lift unless it’s really necessary.

I open a door that seems to lead to the stairs but instead leads to a laundry room. The door next to it is even worse, opening onto a tiny space that doesn’t seem to have any purpose at all, except maybe as a priest hole. Back out onto the corridor, I decide to follow the exit signs. A white figure striding purposefully through a white door, on a green sign that says EXIT. It couldn’t be clearer. And yes – thankfully – it does lead to a staircase. A staircase that goes straight down, two flights per level, to a deadend landing where the EXIT door is locked with a shatterglass handle FOR EMERGENCIES ONLY. I figure there must be a staircase either end of each landing, the one at the other end leading to the foyer and the real way out. So I go back up to the landing above, and follow the corridor round, past endlessly anonymous front doors, to the EXIT sign at the far end. I reason that because I started up from the Lower Ground, I’ve just walked up to the ground floor, so to get to the Lower Ground exit I need to walk back down. So I’m completely confused to find more flats where the foyer should be. It’s only later I realise that because the block is built into the side of a hill, the EMERGENCY EXIT is actually on the ground floor. And what also doesn’t help is that although there are two flights of stairs per floor, there’s an extra, shorter flight down to the EMERGENCY EXIT. In my disoriented state I hadn’t realised that, because of the hill, I only needed to go up one flight of stairs to get to Ground level, then walk along that corridor to the other end and descend two flights of stairs to get back to the entrance on the LOWER GROUND. It’s simple, really, when you draw a diagram. And slow your breathing.

At the time, though, the only way I could escape from the block was to find the lift and press the button for LG with the shakily written EXIT sign taped next to it. I felt like writing something there myself. Thank you.

Back outside, the crisp Spring air never felt so wonderful. I stand a moment filling my lungs, wanting to throw my arms out to the side like Tim Robbins in The Shawshank Redemption. When I look back down I notice a squirrel, perched on the railings of the adjoining park. It has been staring at me as it chews a nut, but when it sees that I’ve seen it, instantly stops. Its tiny, Squirrel Cam eyes zoom in. Then in one clean motion, it grips the nut between its little yellow teeth, flashes its tail, flips on the spot, and vanishes.

wizards, ghosts, vampires

Every time I visit Cutter Street I think of Platform 9 3/4 in Harry Potter. It takes the same crazy leap of faith to make the turn off the busy main drag, to shut your eyes and swing a right between the Pottery Play Barn and the Natural Funeral shop, where no sane person would ever think to hang a right without catastrophically jamming the nose of the car into an alleyway even a cat would pull its whiskers in to enter. But amazingly, the brick walls either side seem to lean away, like they respect anyone mad enough to come through. And the path quickly widens in a magical, funnel-like way, and suddenly you’re parking-up in a generous courtyard with an office block one side and a housing block the other, both of them dropped fully formed from the sky by a giant who wanted to keep them secret.

And all of this seems to fit, because I’ve been asked to come and see a patient who’s seeing ghosts.

The GP is querying a UTI. When they’re bad they can give you hallucinations, so it has to be the most likely explanation – certainly in Gerry’s case, who’s had them before, more vulnerable since he was fitted with a catheter a couple of years ago. The GP has already sent over a short course of antibiotics, just in case, and then asked for us to take bloods and get some more information.

I buzz Gerry’s number. He sounds confused when he answers through the intercom, but there’s a lot of crackling and interference. He doesn’t buzz the main door open, though, so I’m forced to go to Plan B, which is to ring the neighbour in the flat next to his. After a minute or two an elderly guy in a Chelsea football shirt and jogging bottoms appears. It’s strange to see him in those clothes, like he aged seventy years on the journey from his flat to the main door.
‘You’ve come for Gerry,’ he says.
‘Yes. Sorry to bother you. The doctor sent me.’
He bats the air – whether to say it’s no bother or he doesn’t believe in doctors, it’s hard to say.
‘This way,’ he says, turns and leads me in an odd, shuffle trot through the deserted lobby to the foot of the stairs.
Gerry is standing at the top, looking down.
‘Oh!’ I say. ‘You must be Gerry!’
‘I found him outside’ says the guy in the football kit. ‘Says the doctor sent him or something.’
‘I was coming down to let you in,’ says Gerry.
‘That’s great!’ I say. ‘Are you alright if we go to your flat and have a quick chat?’
He stands there, holding onto the rail, thinking about it.
For some reason I say:
‘Permission to come aboard, sir?’ and salute.
Football guy laughs.
‘I’ll pipe you up,’ he says, and makes a toothless whistle.
Gerry salutes, too, which I take as a good sign. Football guy slaps me on the shoulder, says: ‘If you want me I’ll be in my flat. Flat number one.’
‘I rang flat five though,’ I say.
‘Oh. That’s right. I meant five. What did I say?’
‘One.’
‘No. Five. Flat five. I’ll be in flat five.’
I’m not sure if he’s confused or covering for something, but I don’t have a chance to form more of an idea because he turns on the spot and shuffle-trots off.
‘Come on then,’ says Gerry, turning and walking off down the hallway. I sprint up the steps to catch up with him.

Gerry’s flat is lush. It’s filled with dark wooden antiques, old prints of The Great Exhibition and whatnot, marble busts, fern jardinieres and dominating the whole thing, centre stage on a circular, teak dining table, a huge ceramic parrot.
‘How are you feeling?’ I ask Gerry as he settles down in his armchair.
‘Fine,’ he says. ‘I don’t know what all the rumpus is about.’
‘I think the doctor was worried you might have an infection or something.’
‘Why would they think that?’
‘They said you were seeing things. Is that right?’
‘Yes,’ he says. ‘But I’ve been seeing them since I was six.’
‘What kind of things?’
He raises his shoulders, purses his lips, raises his eyebrows, shakes his head repeatedly from side to side, then completely relaxes again. It’s a funny, all-in-one expression, like he’s concentrating all his confusion into one, short mega-shrug.
‘Oh… people – mostly,’ he says.
He strokes the leather arms of his chair.
‘But I’ve always been interested in… you know… what’s it called…?’
‘Ghosts?’
‘Yes. That’s it. The occult. I used to be in a group… a whaddyacallit?… god, my memory… ?’
‘I don’t know. A coven?’
‘No. When you all come together and summon the spirits.’
‘A seance?’
‘Is it? Anyway, I’ve always had the gift.’
‘Do the ghosts worry you?’
‘No. Not at all. Yesterday it was my mum, dad and sister. They’ve been dead twenty years but they were drifting through the flat.’
‘That must’ve been quite nice to see them.’
‘They didn’t stay long.’
I’m tempted to make a crack about that, but I hold off in case it doesn’t help.
I take his blood pressure, temperature and so on. Everything checks out.
‘The doctor wants some blood, too,’ I say.
‘Typical vampire,’ says Gerry.

the rabbit in the room

Rosie isn’t answering the intercom or her phone, and there’s no keysafe, so it’s a stroke of luck that at that exact moment, Frieda, the scheme manager, arrives.

Frieda is a formidable figure. Tall and broad, her thick black hair tightly pulled back and fixed with a comb, her fingers knuckled with silver rings of amethyst and turquoise. ‘Show me ID’ she says, waggling them at me.
‘Come’ she says, after comparing me with the photo.
I follow her in.
Frieda’s office is a converted broom cupboard to the side of the main entrance. There’s really only room for Frieda, a desk, a chair and a filing cabinet, and all her movements have a practiced economy. She unlocks the door with a huge bundle of keys, turns on the PC, grabs sheaves of paper out of the filing cabinet, hangs her gilet up on the back of the door, runs her finger down a wall planner – the whole time talking to me about the problem they’re having with Rosie, one of their residents.

‘It happen from last September,’ she says, slamming the filing cabinet drawer shut with a vigorous sideswipe of her hip. ‘They take her to hospital for scan of head, but she totally freak out. She thought they were going to put the machine in her, and not other way round. So. They never find out what is going on in here…’
She raps her temple twice with her mobile work phone. It makes an audible clunk.
‘For example – did you hear about budgie?’
‘What d’you mean? What budgie?’
‘Rosie have budgie bird. In cage. She love it. The budgie is a very sweet little bird if you like that kind of thing. Anyway, Rosie accidentally smother this budgie.’
‘She smothered it? How?’
‘We not sure. We think she got some idea about budgie and wrapped it up in blanket. And .. well … turns out, not such a good thing for budgie. So Rosie very upset and we had funeral and everything. I had just finish jar of coffee so we put it in that, and we bury in garden. All very nice and so on. But then she was still upset, so we got plastic budgie and put it on perch. And now she think this is still same budgie, and we even have to buy it seed, although we only pretend that part, and use same box.’
‘That’s a shame!’
‘Yes. Whole thing a shame. We’ve been trying to get this thing sorted out but the doctors never do nothing. Social workers, the mental health people, they phone up, they say this meeting will happen…. that meeting will happen … but at end of day nothing happen, and Rosie is still in her flat never eating, and seeing things, and we don’t know what to do.’
‘That’s where we come in. We’ll certainly do our best to move things along.’
‘Yes? You move things along? Well. I like that, but I believe it when I see it.’
She pushes her mask more fully over nose, and glares at me over the top of it.
‘Come,’ she says. ‘We see her now.’

She body-steers me further into the hallway, turns and locks the office door.
‘I am like jailer,’ she says, twirling the bunch of keys with her index finger through the carabiner clip. ‘Good job for you I am here. I do not think she would let you in otherwise.’

Riding up in the lift, Frieda makes a couple of calls to some other residents. She’s ruthlessly pragmatic.
‘They answer phone, hello, they still alive, good,’ she says, pressing the call off. ‘Move on.’
She tells me Rosie had bloods done the day before. I knew this because I’d checked the results on the system and everything had come back as normal. It looked as if the increasing confusion Rosie was experiencing had other, less reversible causes.
‘She’s not coping,’ says Frieda as we step out of the lift. ‘If it were not for me and Junie in flat next door buying food and getting her to eat, she would be dead by now.’
‘You are good,’ I say.
She shrugs, rattles her keys.
‘Is job,’ she says.

*

Out on floor five and Frieda sweeps down the long corridor like the spirit of the place she is, with me trailing in her wake. Midway down there’s a workman kneeling, getting ready to hang a new fire door.
‘Eric’ says Frieda. He starts, almost scuffing the hinge recess with his chisel.
‘Oh!’ he says. ‘Jesus! You made me jump.’
‘Just checking you not sleeping on job,’ she says.
‘No,no,’ says Eric, but it makes me think maybe that’s a thing with Eric.

Eventually we arrive outside Rosie’s door.
Frieda gives me a look that her mask only emphasises, then knocks, loudly, twice.
‘Rosie? Hello darling! Is Frieda, Manager.’
She swings up the bunch of keys, finds the master instantly, and unlocks the door.
‘How are you, darling? I have nurse person with me today to see how you are. Is okay to come in…?’

I follow her into a dark and narrow hallway, doors closed either side and straight ahead, with one door open to the right. We go through into a tiny sitting room with a large birdcage on a coffee table with a plastic budgie taped in the middle of the perch. There are cuddly toys everywhere: rabbits, bears, mice, a knitted woolly mammoth, all of them lined up or arranged in precarious groups on shelves, on a rocking chair, on the top of the telly, on the back and arms of the sofa, on the coffee table – and in the middle of it all, in the last, clear spot of carpet, stands Rosie, her hair wild and her eyes wide, as tiny and frail and bewildered as an embroidered mouse whose plush has rubbed and whose stuffing is lost and whose whiskers, such as they are, twitch anxiously.
‘Hello my darling!’ says Frieda. ‘Is good to see you! This is Jim. He nurse assistant from hospital or something, come to see how you are and move things along.’
I nod and wave as harmlessly as I can. Rosie flinches, blinking quickly and precisely.
‘Hello, Rosie!’ I say.

*

After winning Rosie’s trust with a round of marmalade toast and a cup of tea, she lets me take her blood pressure, temperature and so on. Despite her malnourished state, her lack of personal hygiene and the fact she threw her medication away months ago, her health is surprisingly good.
‘So you’re sleeping on the sofa?’ I say.
She nods.
‘Yes. I can’t go into the bedroom any more because of all the people in there.’
‘Oh? That’s a shame! Who are they?’
‘I don’t like to ask,’ she says. ‘I keep out of their way.’
‘Shall we have a look in there now? I’m here to protect you.’
‘Well… if you think,’ she says.

I open the door into the bedroom. A pair of heavy, red velour curtains are drawn across the opposite windows. Even though it’s a bright Spring day outside, the best the sun can do is make the curtains glow, filling the room with a deep, blood-red gloom. It seems pretty neat, though – a wide, wooden double bed made up with a patchwork quilt, a line of embroidered pillows and scatter cushions at the head end, and propped up on the pillows, a large toy rabbit.
‘What a lovely bedroom!’ I say. ‘Shame you have to sleep on the sofa. And I love the rabbit!’
‘Who’s done this…?’ says Rosie, ignoring me, going up to the rabbit and fussing round it with the pillows.
‘No wonder he’s grumpy,’ I say, but my bonhomie dies a little behind my mask, because in the hectic red shade of the room, it’s hard to dodge the feeling that the rabbit is staring straight back at me, his eyebrows lowering, as Rosie fusses and clucks around it.
‘Shall we draw the curtains?’ I say. ‘Just a little. To let in some light…?’

the king

I’ve seen plenty of Elvis clocks before, clocks made from painted plates where the hands sweep over his portrait; clocks where the dial is set in a golden record beneath a selection of silhouette poses; clocks where his wooden legs swing from side to side at the hip. But I’ve never seen an Elvis clock like the one just above Janet’s head. It’s a brutal, plain cream affair, curved at the top, square at the bottom, like a jukebox I suppose, except without the colour or the interest. There are no likenesses or photos or signatures, just his name above the dial, The King below it, and either side, at nine and three o’clock, 1935 and 1977. You may as well have his gravestone up there on the wall, marking out the time.

The only reason I can think of for having it up there is that Janet was given it as a present. But then – she’s put it in a prominent place, on the wall immediately behind her chair, and not tucked away in the hallway. And to be fair, the other Elvis memorabilia is so awful it’s a relief to have somewhere else to rest your eyes, other than the comedy plastic figure on the mantelpiece doing the jailhouse rock on the mantelpiece in a blade of sunshine, and certainly not the Elvis mirror to the left of it, where the artist has reduced the smoulder to an evil sneer.

It doesn’t help that Janet has a thyroid condition that makes her eyes bulge, or that she’s a little anxious and grips the arms of her chair so tightly her knuckles whiten. In the close, hectic atmosphere of her front room, it’s hard to resist the feeling we’re in some kind of domestic diving chamber, coming up to the surface too quickly.

‘He was only forty-two when he died,’ I say, doing the math from the clock. ‘Such a shame.’
‘Yes,’ says Janet. ‘And do you know how he died?’
I stop myself mentioning anything about giant hamburgers or pills or toilets, and go for something blander than the clock.
‘Heart attack?’
She nods.
‘Forty-two,’ she says again.
‘Yes.’
And then: ‘Terrible.’
Elvis sneers at me from the mirror.

I’d been asked to accompany the nurse on the visit. I couldn’t see any specific risk on the system, but sometimes you have to dig deep to find the original cause, and frankly, I didn’t have time. Plus the visit rounded the day off nicely, so I was happy enough to tag along. It was a simple visit, too, so there really was nothing for me to do other than sit opposite Janet and talk to her about this and that, and make her some tea, and generally ease things along whilst the nurse cantered through her review. For now she was in the bathroom, dipping a sample of urine, and I was sitting in the front room, marking time with the clock.

‘I went to Graceland,’ says Janet.
‘Did you?’
‘Yes.’
‘Wow! What was that like?’
‘I went with the club. It was a long time ago, before they let you in the house. I saw the gardens. I saw the swimming pool. I saw the grave.’
‘That’s amazing! The grave!’
‘Yes. I saw it all.’
‘So that was a little while ago…?’
‘Nineteen eighty-two. But then my aunt died and I was left all alone.’
‘Oh. I’m sorry to hear that.’
The nurse strides in from the bathroom, waving a dipstick in the air.
‘All clear!’ she says.
Janet turns her enormous eyes in her direction.
The clock ticks loudly on the wall.

can I move

Callum is watching Butch Cassidy & The Sundance Kid. Butch and Sundance have escaped to Bolivia and are trying to get hired as guards on a mule train. The foreman wants to know if Sundance can handle a gun, so he throws a rock a little way off. Sundance adopts his gunslinger stance, but the foreman says he just wants to see if he can shoot, taking the gun out of Sundance’s holster and putting it in his hand. Sundance misses. The foreman turns away, but then Sundance says : ‘Can I move?’, draws his gun, shatters the rock, spins the gun around and slips it back in his holster. ‘I’m better when I move’ he says.

If there is a subliminal message in this for Callum, he quickly shoots it down – as ruthlessly as Sundance – with a remote control instead of a pistol.

‘Alright?’ he says, returning the remote to a pocket slung like a holster on the side of the recliner.

I couldn’t tell you how many times we’ve seen Callum. It always follows the same pattern. Callum falls over, the ambulance picks him up, then refers him to our team for review. Callum is middle-aged and morbidly obese, dividing his time between the recliner, the bed and the floor. He’s locked-in to a self-destructive loop of ill health and dependency, his whisky drinking and poor diet making him heavier and more unwell, which makes him less mobile and more likely to fall, exacerbating his depression, driving him back to the whisky. The change he most needs to make is to stop drinking, of course. Callum knows that as well as anyone. It’s difficult though. The drinking long ago stopped being a way of making him feel more relaxed and comfortable in the world; these days he drinks just to stay level. Mentally, anyway.

We check him over, talk through what happened, review his equipment, read through his notes. Environmentally his flat is as good as it gets: clean and clutter-free, with plenty of room to move with his walker, more grab rails around the place than a cross-channel ferry, emergency pull cords, carers coming in three times a day.
‘It’s embarrassing,’ he says. ‘I hate being like this.’
We talk about the possibility of another referral to the substance abuse service.
‘I’ve done all that,’ he says. ‘Nothing happened’ – as passively as if he were describing a trip to the garage to have a new exhaust fitted, and for some reason they didn’t bother. ‘I don’t know what to do.’

We end the visit as we always do, telling him we’ll update his GP.
‘Good luck with that,’ he says.
I shrug.
‘It’s easy for us to come back,’ I say. ‘You know how it goes.’

As I write the notes he puts the TV back on again. It’s the last scene. Butch and Sundance are badly wounded, reloading their pistols, crouching behind a wall. Meanwhile, dozens of Bolivian soldiers have taken up position around the place, ready to shoot. We know Butch and Sundance are doomed, but still, they share some more cute banter, something about Australia and a future we know they’ll never see. Suddenly Butch says ‘Wait! Did you see Lefors out there?’ Sundance says he didn’t. ‘Good,’ says Butch, relieved. ‘For a minute I thought we were in trouble.’ They run out into the open. There’s a volley of shots. The film freezes. The closing music plays.
‘Thanks a lot, guys! See you later!’ says Callum.
And he pours himself another drink.

junk epiphany

I’ve never seen so much food. Walking into the kitchen I stop and shake my head in wonder. I’m like Howard Carter stumbling into the tomb of Tutankhamun, suddenly confronted by shelves piled high with fabulous riches: sweet chilli noodles; party packs of M&Ms; currant pastries; catering packs of crisps and cheetos (not for resale); a Colin the Caterpillar, happily gutted from the middle out; cream cheese n’chive pretzels; a plate of fruit (untouched); chocolate biscuits; chocolate rolls; chocolate truffles, chocolate for injection (I think) – and as if that wasn’t enough sugar, a shrink-wrapped twelve-pack of energy drinks.

It’s a perfect storm of junk food, and the reason for it is that there’s been a perfect storm of people leaving.

There are always good reasons to go. It might be the exorbitant cost of accommodation in the south. It might be better job offers elsewhere, better opportunities to train, or upgrade, or move into management. It might be the need to do something different, to shake things up, to rediscover what it was that drew you to nursing in the first place, or confirm what it was that made you want to quit. It might be burn out, ill-health, retirement, whatever. The fact is, though, if you take a step back, and breathe, and cast your eyes over the broader picture, you have to think this team’s retainment record is shot. It’s the kind of graphic you’d hastily click through in a presentation, or – ideally – omit from the slideshow altogether.

Honestly? I don’t know why things are so bad (national pandemic aside). Nursing in the community isn’t for everyone, that’s a given. You don’t have the immediate support you have in a hospital. You’re not surrounded by doctors and nurses and administrators and cleaners in a well-lit building with every kind of machine and every kind of clinician to work them. In a community health team, every day you’re stepping out into the medical wildlands, with only a kit bag, a nose for danger and a phone. It’s a level of responsibility that has some practitioners quickly developing a twitch, but for some it’s the perfect place to practice their skill. You’re forced to improvise, to adapt to the crazily different scenarios you walk into: environmental, social, medical. And until they develop a drone that will hover at your shoulder and offer reassurance and advice, YOU are the drone, and you’re flying by yourself.

*

It’s late in the evening. I’ve swapped hats, from nursing support to office administrator, helping on the phones, taking referrals, troubleshooting. I’ve just come back from the sugar nirvana of the kitchen with a handful of M&Ms, and I’m busy tossing them down my beak with one hand whilst I work through the patient list with the other. And suddenly – whether it’s something in the blue M&Ms, or that lucent kind of tiredness you get when you’ve been concentrating for hours – but I have a sudden moment of insight, and I’m not just scrolling through names on a screen anymore but through a landscape of scenes, drifting through them like a tiny, shiny, sugar-coated ghost. The woman who was discharged home to die, and promptly did die, that very afternoon, before any of us had a chance to see her. The man who self-discharged from hospital after an overdose, and went back to his boat to drink whisky and consider his options. The woman struggling to look after her husband whose dementia means he punches the cot sides all night and day. The man who took out his phone to film the occupational therapist when she called on him to see what he needed. The woman who nursed her husband through his last years, and now faces her own decline completely alone. The woman who cannot cope at home, but doesn’t want to leave her home, and the exhausted daughters who want us to simply put her in a home. The woman starving herself, staying in bed so long she has pressure sores. The woman with the new stoma, who died on the table, and saw God, and came back, and how angry she is about that, and the business of wearing a bag. Each scene merging into the other, blurring on the screen, until it’s not one or two patients anymore, but a never-ending roll call of problems, because for every one we solve and discharge from service, another two referrals come in.
‘GP on the line’ says April, the call taker in the hub. ‘Wants to know if we’ve got capacity for a faller…’
I toss down the last of the M&Ms, smack my hands clean, pick up a pen.
‘Put ‘em through.’

Because – I don’t know – what else is there?