please welcome on stage

Thomas is alert but strangely neutral, propped up on the ambulance trolley, his white hair wild on the pillow, his mouth slack. He’s put on so much weight it’s taken a team of four to wheel him off the ambulance, up the drive, through the portico and into the house. Jenny the OT and I have arrived just in time to help, although there’s not much for us to do other than carry in all the bags of personal possessions, drugs and so on. The patient transport crew are a loud and pleasant bunch, eyes smiling over their masks, plenty of to you / to me banter as they patslide Thomas into bed, make things good, get ready to go. One of them nods for me to follow her back out to the truck, though.

‘I don’t know what help you can give them,’ she says. ‘But I gotta tell ya – I’m worried about the daughter. She’s a donkey on the edge. See what you think. Personally – I don’t know – I wouldn’t put money on it.’

The story is that Thomas went into hospital after a fall, stayed a month, then got transferred to a nursing home for a few weeks’ rehabilitation. Meanwhile, the hospital OTs visited the house, put in a hospital bed, stand aid, commode and so on, and then referred him to us for more therapy and nursing support, along with bridging care until a full time agency can take over. All in all it’s about as much as anyone can do short of adoption, or residential care, of course. But we’ve been tasked to visit for the initial assessment, to see how it all looks, and if the plan is workable.

The house is like a spacious, somewhat incongruous pink Spanish villa, set back on a rise at the head of the close. Thomas’ hospital bed has been set up in the L of the vast, low-ceilinged living area, with bare stone walls, a heavily-timbered fireplace, brasses hanging here and there, a hunting horn, a few framed portraits. Even though it’s hot and bright outside, the late summer morning doesn’t penetrate overmuch; what light there is only makes it so far through the patio glass at the far end, lying like a glossy green sweat on the backs of the clubby sofas and chairs.

In fact, the scale of the place is a little overwhelming. It’s the details that make you dizzy. On the wall behind the head-end of Thomas’ bed is a giant oil-painting of a horse’s head; at the foot of the bed, on a granite pedestal, a fish tank filled with tiny silver fish.

Thomas’ daughter, Helen brings in a giant mug, filled almost to the brim with tea.
‘Don’t spill it!’ she says to him, putting it on the overbed table.
He glances down, shakily jerks his hands, the tea slops.
‘Look what you’re doing!’ she says.
I take the cup from him, move the table to one side, hand the cup back to Helen.
‘He really needs one of those spill-free mugs – you know – the ones with the spout.’
‘What – like kids use? For kids?’
I nod.
‘That’s it!’
‘Have you got any?’
‘We don’t carry them. But you can get them anywhere. The supermarket, pharmacy…’
‘A beaker for kids? You mean Tommy Tippee?’
‘A lot of people use them.’
She looks horrified, takes the tea back into the kitchen.

Whilst Jenny starts doing the paperwork and an audit of the equipment we’ll need to check, I run some basic obs. It’s immediately obvious things aren’t right.
‘I think this is looking like a failed discharge,’ I say, looping the steth back over my neck.

Alice and Frank, two of our most experienced carers, turn up for the lunchtime call. It’s good to see them – they’re so cheerful and grounded, it immediately makes any situation a hundred times better. Between us we set about sorting Thomas out, log-rolling him, tearing off his pads, cleaning him up, putting on fresh pads, changing the sheets, sitting him up again. Thomas coughs throughout. Frank raises his eyebrows at me.
‘Tested for Covid?’
‘A month ago.’
‘Oh-kay…’

Helen appears in the doorway. She stands watching us, her arms folded, staring at the pile of sheets on the floor.
‘What’s that?’ she says. ‘Why’s that there?’

Jenny goes over to her to explain the situation whilst we finish up.
‘They’ve just had to clean your dad up and make him comfortable. Have you got a washing machine?’
‘What do you mean? I’m not doing any washing.’
‘It’s not too bad, Helen. It just needs tossing in the machine with a tab of something.’
‘Well you can do that because I’m not. Isn’t that what you’re supposed to do?’
‘No, I’m afraid not. We’re effectively an emergency service. The carers will be coming in four times a day for bed washes, pad changes, and then simple meal prep and medication if that’s needed, too. But everything else – things like washing, cleaning, shopping – well, they’re all classed as domestic chores. You’ll need to find someone to cover that if you can’t.’
‘Well I’m certainly not doing it,’ she says. ‘Why should I? I’m not touching anything soiled.’
‘You can put gloves on.’
‘Gloves? Gloves? I’m not putting gloves on. Look – you do what you have to do, but I can’t … I just can’t… I’ll go and stay at a friend’s if that’s what you think’s going to happen.’
Jenny looks over to me.
‘It might all be a little academic…’ I say, feeling Thomas’ pulse again. He sits propped up on the pillows, the focus of everyone’s attention, his mouth bouncing up and down, mute as a ventriloquist’s dummy who still has a whole bunch of things to say – important things, mad things, funny things – but the hand some time ago let go of the lever, and left him on stage to carry the show alone.

fridge magnets

Mr Yelnats talks with an unending cadence, running one sentence into the next. It wrong-foots me, because when it sounds like he’s coming to a full stop and I’ll be able to answer some of his anxieties, he picks up steam again and carries on. The result is that I spend the next five minutes occasionally drawing a breath ready to speak, then letting it out slowly again, nodding sympathetically, trying to keep a hold on the points I’ll need to cover to calm him down. In the end, though, I’m driven to talk over him a little, and ease him to a stop, like intercepting a bolting horse by standing in its path, holding my hands out and stroking its nose.

‘Well first of all – has anyone told you who we are?’ I say.
He changes his position on the sofa again, throwing his right arm over his head to scratch the opposite ear, then changes back again.

‘No,’ he says. ‘No they haven’t. What they did say is that all this would be done. I mean – I wasn’t expecting brass bands and flags in the street. I mean – I’ve been away a long time but I’m not stupid. I know how these things go. But why did they say it’d all be done? I’d have the things that go over the toilet. I’d have the stair rails. I’d have the thing that goes over the bath. A perching stool, whatever that is. I mean – I wasn’t expecting a team of workmen drilling holes in the wall as I walked in the door. This isn’t the movies. But still – a promise is a promise. Why did they say they’d do these things if they weren’t going to happen? I mean …’

‘I’m sorry you were given the wrong impression about how it all works, Mr Yelnats,’ I say. ‘But let me just explain…’

‘I’m not as bad as some. I’m pretty bad, as you can see. But I do my best. I can get about – of sorts. I’ve been away three months and things are a bit difficult at the moment. Don’t get me wrong. I’m an independent sort of chap. Still. My wife died six years ago and I’m still getting over that. Not that you ever do.’

‘I’m sorry to hear that.’

‘It’s as well to know your limits. I want to get better. I think I can get better. In fact I’d go as far as to say I expect to get better. But I’ll need a little help. As things stand I’m not sure what I can do and what I can’t do. Let me tell you something. When I was on that ward…’

He holds out his hand, spreads his fingers and taps them one after the other with the other hand, listing all the things he was told on the ward. And – actually – it comes down to five things. He’d have a toilet aid, a walking frame for upstairs, a bath board, a perching stool, and care support all waiting for him when he got home.

‘Okay,’ I say, as evenly as I can. ‘Okay. First things first. Let me quickly tell you who we are. We’re an NHS community health team. We’ve got lots of people on the team – physios, OTs, nurses, pharmacists – you name it. It’s a pretty big team. We’ve also got a small bank of carers who give emergency support to patients. Our job is to either support people being discharged from hospital – like you – or to stop them being admitted in the first place. So the hospital has referred you to us, and I’ve come round on a kind of fact-finding mission to see exactly what it is you need.’

‘Let me stop you there…’ he says.

‘Just one more thing,’ I say. ‘And this is pretty key. We’re a short-term service, so we work very very quickly. We like to move things on as fast as we can. If someone needs longer term help, we refer them on to the District Nurses or any of the other specialist teams. And if they need longer term care, we refer them on to full-time care agencies.’

‘Yes, yes, I get all that,’ he says, as I nod and gesture for him to continue. ‘But why did they say it’d all be in place when it wasn’t?’

‘I don’t know. There are two types of arrangement. One is an access visit, where an OT from the hospital comes to the house to put in essential equipment ahead of the discharge, and then there’s a referral to us.’

‘What – coming to my house when I’m not here? I wouldn’t want that.’

‘Okay – so that’s probably why they referred you to us. But as I say, we work pretty quickly.’

‘How quickly?’

‘I could call the office now and see if they’ve got availability for an OT to come out with the stuff. They’re horribly busy, but it’s worth a shot.’

He frowns at me.

‘What are you like with toilets?’ he says.

‘Toilets?’

‘My toilet won’t flush.’

‘Oh. Well. I’m not a plumber. But I could have a look…’

He struggles up out of the sofa, waving me away when I go to help. It’s like watching a daddy long-legs trying to free itself from a glob of treacle.

‘That’s quite low for you,’ I say.

‘It’s comfortable,’ he says, puffing and straining. ‘I’m used to it.’

Eventually he manages it, and after taking a breath, straightening his cardigan and swiping his hair to the right, he staggers out of the room with me following behind. We pass along through a narrow kitchen, Mr Yelnats using the counters and cupboards for support, me with my hands out like an anxious parent ready to catch.
‘I need some rails here,’ he says, slapping the wall.
‘I can see that.’
‘It’s in there,’ he says, chinning me in the direction of the loo.

A creamy green toilet with one of those cisterns with a push-button flush. I’ve really no idea, but I take off the heavy lid and look inside. The water is up to the top. There’s a strange looking plastic box on a push-fit over the handle spindle. I pull it off, flip the lid open and try to figure out how it works. When you push the button on the outside of the cistern, a rod pushes a sprung thing that tugs on a wire that feeds down a tube into some other thing that operates the flush. The sprung thing is sticky, so I wiggle it. Eventually – miraculously – it seems to work again. The water empties with a gratifying rush.

‘Don’t it?’ says Mr Yelnats, waiting outside the door.
‘All done! Seems to be fine now.’
But … when the flush is finished and the water starts to come back into the cistern again, the water level doesn’t go beyond a couple of inches, and all the excess runs off into the toilet bowl. No amount of wiggling makes any difference.
‘Oh,’ I say.
‘What?’ says Mr Yelnats.
‘I can’t stop it filling.’
‘Let me see…’ he says, and comes into the toilet. There’s no room for both of us at the loo, so I squeeze past him. Eventually he supports himself on both hands, staring down into the noisy cistern.
‘What have you done?’ he says.
‘Like I say – I’m not a plumber…’
‘It’s going to run like that without stopping now.’
He tries some wiggling, too, but nothing makes any difference.
‘Let me have one more look,’ I say. We go through the same elaborate manoeuvre as before, and swap places.
In the end, for want of anything else, I get a Toilet Duck and wedge it under the ballcock, stopping the water about half-way up the cistern.
‘It’s only temporary,’ I tell him. ‘I’m afraid you’re going to have to get a plumber in.’
‘Where am I going to get a plumber?’
I shrug.
‘Do you have any family nearby? Any friends, or…?’
‘No.’
‘The internet?’
‘Hmm,’ he says. ‘There’s a plastic bucket back in the kitchen. Fetch that in here, would you? I can use it to flush things through.’
‘Okay.’

I find the bucket on a stool beside the fridge. The fridge is covered with a grid of fridge magnets – a Picasso portrait, an abstract pattern, hokey one liners with cartoon illustrations: My wife might not always be right but she’s always the boss or There’s nothing wrong with me that a little chocolate won’t fix. A Fender Stratocaster. A Triumph.
‘Where’s that bucket?’ shouts Mr Yelnats.
‘Coming!’

thank god it’s not friday

Fridays are the worst.

It’s more than just the hospitals clearing the decks before the weekend. There’s something else about the day – an end-of-the-week, last-chance, store-closing, now-or-never vibe that means from shutters up to shutters down the phone never stops ringing and every call is a crisis. Coming to work at eight on a Friday, you feel like stacking sandbags round the desk and putting on a tin hat. As it is, you make a cup of tea, get a fresh notepad, a pen and a highlighter, open up as many useful programs as you have access to on the computer, crack your neck, and wait.

But you can oversell these things, of course. And there’s a certain satisfaction to be had from stumbling from one thing to the next, like a clown fireman at the circus. Once you surrender to the chaos, and focus on the audience, it’s actually quite a rush.

Luckily, I only had to work the phones till three, when I was released to go on a couple of visits. It was so busy, though, thank goodness my replacement actually showed up. If they hadn’t, and I’d had to stay for the rest of the shift – well – who knows what would’ve happened? I’d probably have been found by a cleaner, alone in the office, lit by the ghostly glare of the screen. They’d have tapped me on the shoulder.
‘Are you alright?’
And I’d have swung slowly round. And the cleaner would scream – because they’d see my ears were merged with the headset, my hands with the armrests, my eyes would be flickering like two little plasma screens, and the veins in my neck and face would be spread all over like wires.

*

The first visit is easy enough. The second is a disaster.

Being exhausted doesn’t help, and the fact that my patient, Mr Reece has only just arrived back home after being discharged from a rehab place, weeks and weeks after he went in. All he wants to do is smoke a fag and watch the wrestling.

His flat is in a wretched state, lit by two shadeless, ineffectual, energy saving bulbs. Mr Reece is sitting in a ruined armchair, an electric scooter to his immediate left, a zimmer frame to the right, and a TV just in front. Around the chair is a scattering of papers, leaflets, unopened mail. In the corner of the room is an unmade bed, the centre of the mattress sagged and seamy. The whole place is suffused with a settled fug of neglect.

‘Hello Mr Reece!’ I say, as brightly as I can, struggling in with all my bags. ‘Sorry to disturb you so soon after you got home, but we’re a short term service and we need to get things started.’
He frowns at me, then pointedly plants a cigarette between his lips and reaches for a lighter.
‘Would you mind not smoking whilst I’m here?’ I say, putting my bags down and then wringing my hands together, like an apprentice vicar leading prayers for the first time.
‘Why?’
‘Because I’ll stink of smoke the rest of the day. And it’s not good for me. Sorry! I won’t keep you long.’
Mr Reece twists his lips together with a displeasure so violent the cigarette falls out into his lap.
‘You’ve got ten minutes!’ he snaps, throwing it onto the scooter. Then he jabs his hands towards me, palms flat, fingers spread wide. ‘Ten!’
‘Okay. Thanks. Well – has anyone told you who we are?’
‘No. They haven’t.’
‘Oh. I’m sorry about that. Well – we’re an NHS community health team whose job is to support people being discharged from hospital, or stop them going into hospital in the first place. Mr Reece? Are you okay?’
He’s leaning over the side of the armchair, rootling about in a pile of mail and newspapers.
‘I had £850 there and it’s gone.’
‘Oh. Shall I help you look?’
‘No. You stay there.’
‘Okay.’
I watch him scrabbling around for a minute. He struggles to get out of the armchair. When I go forward to help he tells me to keep away. He tries using the zimmer, but it gets caught up in the scooter. I offer to move the scooter.
‘Leave it!’ he says. ‘Leave that thing where it is!’
He abandons trying to use the zimmer, and shuffles around the chair instead, using the arms and the headrest as a support. He kicks his bare feet amongst the detritus, like a bad-tempered park keeper through a heavy fall of leaves, peering down.
‘Mr Reece? If you had £850, and it’s not there anymore, do you think it’s been stolen? Shouldn’t we be calling the police?’
‘I don’t know,’ he says. Then he stops, straightens, and – gripping the back of the chair with his hands – draws a bead on me down the sharp crook of his nose. ‘We’ll see if I find it. Won’t we?’

annie’s yuccas

Outside John’s window are two enormous flowering yucca plants, bees bimbling drunkenly up and down the spikes.
‘Look at that lot,’ he says. ‘What d’you reckon?’
‘Pretty impressive.’
‘And they’re socially distanced, n’all. I was going to put a mask on ‘em, but I thought the bees would get annoyed.’
‘That’s a good one! I like that!’
‘Yeah!’ he says, ‘This bungalow, it’s the best plot in the street. It’s got the garden. It’s got somewhere to park the car. ‘Course, the garden was really Annie’s area of expertise. But she’s gone now and I’m not so good as I was on my pins. Still – can’t complain. Honestly, if I was a millionaire I couldn’t be any better set up. I’ve got everything to hand, look. The kitchen, the bathroom, the bed. I’ve got a TV. I’ve got my iPad for doing the email and putting a few quid on the horses. I’ve got friends next door who do my shopping and run the hoover over. I’ve got family who pop in when they can. So you tell me. What better life could a millionaire have than what I’ve got?’
‘I can’t think, John. It seems pretty great.’

And it’s true. It is.

John is ninety-two, but he’s been lucky with his health – that, and the fact he played a lot of sport and stayed active all his life. He never smoked, he says, and only drinks on special occasions, which is ‘any day with a D in it.’

He sits upright on the armchair, his gnarled hands restlessly moving, from a stroking kind of action on the ends of the arm rests, to a vigorous rubbing of his bulbous nose, to a dog-like scratching of his ear, then back to the arm rests. It’s like watching an old but well-maintained tractor, idling in the yard before rattling off down the lane.

But his demeanour suddenly changes when he tells me what happened with Annie.

‘Wa’aall,’ he says, batting the air. ‘They messed up the appointments and whatnot. There was a lot of toing and froing. Me ringing the surgery asking whether the blood results was back yet; the surgery saying ‘what blood results?’ and this and that. You get the picture. Till finally when they found out what she had it was too late. She got took by the cancer. It wasn’t easy. And then there was this in-quiry, see? But I tell you what – I was prepared. I had all the dates written down, all the lost appointments, all the tests they missed. And I sat up in that room in the hospital, with the consultant and all the rest of them sitting opposite me. And the consultant he said she would’ve died anyway. So I got a bit hot, I can tell you. And the woman from the wherever-she-was-from, she said I had to show a little respect. So I said where was the respect you showed my Annie? Where was the respect there? ‘Course, they went quiet at that.’

He shrugs, strokes the arms of the chair.

‘It’s all in the past now,’ he says. ‘I got a letter saying sorry, so there’s that.’

He looks out of the window, at the bright sunshine pouring down into the garden, the hedges looking a little ragged now, the shed leaning to the right.

‘What about them yuccas, though?’ he says. ‘Socially distanced! Hey?’

pellets

There’s an approximate number one with a crooked arrow beneath it, crudely painted in black, nailed to a board beneath the crappy intercom at the front of the house. I guess the Cartwells have a flat round the back, so I head in that direction.

Beside the front door to Flat One is a large electric button, so new it stands out from everything else. In fact, it’s such a contrast – the bright plastic box, the imposing but ramshackle old house – I’m surprised the whole thing didn’t cave in when they screwed it in. But then again, I’m guessing they took the safe option and used glue.

There’s a thick carpet of blue slug pellets scattered in front of the door. Two or three cartons worth. They must have a terrible slug problem. Or maybe they think it’s good for health visitors, too? Pellets crunching underfoot, I reach out, press the button and wait.

Nothing.

I’m not sure it rang anywhere, but sometimes it’s difficult to tell.
I look around. Waggle my feet experimentally on the pellets.
Press the button again.

Nothing.

Is that even a button? Maybe it’s a fancy design feature and the button’s somewhere else. Maybe it’s actually a camera. I lean in to look, and then lean out again, not wanting to scare them. Feel around the box. No – it must be the button. Why would you have a feature on a doorbell that looked like a button but wasn’t? That’d be crazy.
Maybe I just didn’t press hard enough.
I prod a little harder. A couple of times.

Whaaaat? cries a voice from deep inside the house. Why’d’ya keep pressing the fackin’ button? Who ARE you?
‘Oh! Sorry! It’s Jim – from the hospital. Come to see Mr Cartwell…’
I rap on the door with my knuckle and gently push it open.
‘Alright if I come in…?’

There’s a steep flight of stairs leading straight up to a landing. An elderly woman leaning over railings at the top, looking down. She looks insanely hostile – flaring white hair, wide eyes, and a great toothless mouth. She looks down at me with such a rapt expression, I’m worried she’s suddenly going to extend her neck down the stairs and snap me up – head, bags, lanyard and all – in one convulsive gulp. Luckily she stays where she is, gripping the bannisters.
‘Who sent you?’ she says.
‘I’m so sorry to disturb you. It was the hospital. When Mr Cartwell was discharged they asked us to come and see how we could help.’
‘Urgh,’ she says (or sounds like). ‘I suppose you’d better come up then.’
She lets go of the bannister and shouts ‘Eric! It’s someone from the hospital to see you.’
A voice from a room somewhere.
‘But I’ve only just got ‘ere.’
‘C’mon. Get up. He’s come to see you he says.’
‘What for?’
‘I don’t know. He’ll tell you.’
‘I was having a kip.’
‘Have it later.’
Inaudible curses.
‘C’mon, then if you’re coming.’

I walk up the stairs, scattering blue pellets behind me like a cat leaving a litter tray.

‘Sorry to be a nuisance,’ I say.
‘Go in the sitting room,’ says Mrs Cartwell. ‘He’ll see you in there.’
‘Okay. Lovely. Thanks.’

The flat is tiny, the narrow layout made worse by all the clutter. There’s just enough room to move from one place to another, and when Mrs Cartwell comes in we have to choreograph each move in advance to make it work.
‘So they obviously didn’t tell you who we were,’ I say, looking for somewhere to dump my bags but giving up.
‘No,’ she says. ‘Who are you?’

We’re interrupted by Mr Cartwell, wheezing and puffing and cursing as he comes down the corridor towards us. His belly is so distended, it reminds me of the spacehopper I used to have, bouncing round the garden, tugging on its ears. It’s such a squeeze for him, moving through the flat, and he fits the width of the corridor so perfectly, it’s hard to resist the idea that he made these walkways himself, just by moving around, and if he’d stayed in hospital a few months longer, the whole place would’ve closed back up again, and that would be that.

Mrs Cartwell waves me to the right, then she moves to the left; I move to where Mrs Cartwell was; Mr Cartwell rolls into the room, eventually easing himself into a decrepit computer chair that creaks and sags alarmingly.
‘What’s all this about?’ he wheezes, flapping the sides of his open dressing gown like wings. And when he turns to look in my direction, he doesn’t open his eyes.

old mrs crusoe

The end of the street is blocked by fire trucks. The thrum of the big diesel engines, the frenetic scattering of blue lights – it’s all quite shocking in this narrow huddle of old terraced houses.  I can’t see any smoke, though, and there doesn’t seem to be much happening, but I suppose you can’t always see what the problem is. Maybe it’s a false alarm, or someone trapped. Whatever the reason, the only way out that end of the street is by hot air balloon. If they’re still on scene by the time I’ve finished this call, I’ll have to reverse out the way I came in. I just hope another engine or an ambulance doesn’t follow me down, in which case I’ll be stuck.

It should only be a quick visit. Mrs Baker was discharged home today and needs someone to deliver a perching stool and generally check that everything’s okay. The hospital notes are pretty extensive. It sounds as if she’s well set-up. The perching stool is just the blue and white cherry on the cake. 

I struggle over to her house with my bags and the chair, and ring a cracked bakelite bell so old I can hear it ringing in a hallway sometime around nineteen fifty.

Eventually Mrs Baker opens the door.

‘Sorry about that, darlin’!’ she says, puffing a little, patting her hair. ‘Everything’s such a performance these days.’

She lets go of the door then trudges around in a circle using the walls for support, each step as tentative as an elderly moose walking out on a frozen lake. I follow her down the hallway into the sitting room. 

‘I don’t want to fall again,’ she says. ‘I’ve had enough of all that business.’

‘Haven’t you got a zimmer frame?’

‘I have, but y’see – it’s a job to use it in the hall. I keep the frame in the big room.’

‘I’ve got the same problem outside,’ I tell her. ‘There are fire engines blocking the street.’

Are there?’ she says, stopping and glancing back at me in a scandalised kind of way. ‘I ‘spect it’s where they built all them new flats. They knocked Terry’s corner shop down and put up half a dozen little flats instead. Not that you could call ‘em flats. You couldn’t get much more’n a cat and a packet of biscuits in them. And shoddy? C’uh! You’d be better off in a cardboard box. And the alarms! The alarms are always going off.’

She batts the air.

‘Doesn’t bother me. I’m deaf as a post, so that’s a blessing.’

She’s not wrong about the big room. At some point the dining and front rooms have been knocked into one. There’s a galley kitchen leading off at the back, a bathroom next to it, but everything else is set up for single-room living. There’s a bed with a handrail in one corner, a commode, a high chair, zimmer frame, cantilever table, grabber – just about every bit of equipment you could want. It makes me think of Robinson Crusoe in a stockade filled with improvised and useful things, everything to hand, utilitarian, just right. 

‘You can put the stool down there in the kitchen,’ she says, waggling her hand in that direction. ‘I’m gonna do my little strip washes at the sink.’

Afterwards I have a quick look around but there’s nothing else to be done. She has carers coming in three times a day, family nearby – really, it’s a neat little set-up. 

‘That’s me then,’ I say, picking up my bags. ‘If anything changes and you need us back, just talk to your doctor.’

‘Thanks for coming, darlin’,’ she says. ‘It’s nice of you to take the trouble.’

‘Pleasure!’ I tell her. ‘I just hope those fire engines have gone.’

‘Oh – they never stay long,’ she says. ‘But I’d get out while the going’s good if I was you.’

looking for geppetto

The front door is open. When I go in and close it, I see a sign thumb-tacked just above the letter box: Keep The Door Closed. 

I can hear Raymond talking animatedly on the phone in the front room. When I stick my head round the corner and wave, he waggles his free hand in the air and continues:

This is absolutely fucking ridiculous…. of course I can’t tell you the card number… well, for the simple reason I’ve lost the card. That’s the entire purpose of my call. If I had the card to read the number I wouldn’t be ringing you, would I? No I won’t calm down. I demand that you reinstate the two hundred pounds that was stolen from my account…. I don’t KNOW how they got the pin number. They’re CRIMINALS. That’s their JOB. All I want is for you to do YOUR job and give me back my money….

Something happens with the phone. He curses, holds it away from his face, bangs it twice on the arm of the chair and then tosses it out into the chaos of the room. 

‘Battery’s dead!’ he says. ‘You couldn’t do me a favour, could you?’

‘Of course.’

‘Locate the base that’s somewhere over there and charge it up again?’

The little front room is in a mess, as devastating as if flood water had unexpectedly rushed through the house and then back out again, leaving a tangled tideline of random stuff – trainers, trousers, duvet covers, exercise bike, milk cartons, who knows what. The only clarity in the place are the bookshelves, safely screwed to the walls out of harm’s way, the books neatly aligned in height order. They mostly seem to be about film, especially animation. Which makes sense, given the display on the hallway wall of some early Disney drawings – character studies of Jiminy Cricket, Figaro the cat, Pinocchio. 

I’d had some warning of the state of play this morning. The therapist who’d been in to see Raymond the day before had written an illuminating note: Patient reports that a stranger visited last night with a bottle of brandy – stayed for sex – stole money on his card. Police informed. 

Notes further back show that this isn’t an unusual event. Raymond has a long history of alcohol abuse and all the associated complications, medical and social. I’ve come round to dress the wound on his head, and generally see how he’s doing. 

He has no recollection of the fall.

‘Is that unusual for you?’ I say, gently cleaning the wound with saline, holding a swab to his eyeline to catch the drips.

‘No, sadly,’ he says. ‘It’s the booze, of course.’

‘I read that you tried a detox programme last year – which is good.’

‘Is it? Well – you get shunted into these things. My heart wasn’t in it. I’m afraid I didn’t just fall off the wagon I rolled it over and took everyone down with me.’

‘Worth trying again…?’

‘I don’t think so,’ he says, with a deflationary sigh. ‘It’s not worth it.’

I photograph the wound, dress it, check him over more thoroughly. He’s got lots of injuries, old bruises, new bruises. It’s like he drinks a bottle of brandy then throws himself into a giant tumbling machine. It’s a miracle he ever emerges. 

‘I love the Disney drawings you have on the wall,’ I say. 

‘Thank you.’

‘I remember the first time I saw Pinocchio. That scene where Lampy turns into a donkey. Good grief! And that bit where Pinocchio’s walking on the sea bed with a rock tied to his tail. Calling out Faaaa…ttttthhhherrr! And all the seahorses and clams and things come out to look. But when he asks them if they’ve seen Monstro the whale, they look terrified and disappear! I mean – what an absolute freakin’ nightmare!’

‘Yes,’ says Raymond. ‘I know. Story of my life.’

a ceramic pelican

The muddled wave of sycamore trees growing up along the embankment at the back, the viaduct rising high above the houses in a straight line to the heart of town, the shuttered pub on the other side of the road, the makeshift garage with the stack of tyres and the rusting car up on blocks – everything conspires to give this street a neglected, backwater feel.
I’m meeting up with Magda for a joint visit. There’s been a safeguarding raised against Bob’s wife Geena. We’re here to support each other, to see how he is, how things are today.
‘Jimmy boy!’ says Magda, tossing her hair back and holding it in place with her blingy sunglasses. ‘S’up?’
We talk a little about the situation before we knock.
‘I doubt she’ll even answer the door,’ I tell her. ‘Did you read the notes? She’s been turning everyone away. Going mad. And even when she lets them in, she abuses them and throws them out pretty quick.’
‘Sounds like my kinda girl.’
‘The social workers are on the case.’
‘Well!’
‘She even swore at Pete the physio and threw him out.’
‘Peter? Man! That’s like being cruel to puppy.’
‘I know! So – I’m not sure how far we’ll get.’
‘You want me to go first, Jimmy? It might be dangerous.’
‘Okay.’
‘Okay.’
She goes up the steps to the front door and knocks, heavily, like a debt collector or something. We wait a while. She knocks again.
I’m just about to lean over the railings and peer through the front window when the door unexpectedly opens.
A sixty year old woman dressed in a hornet stripe jumper, purple slacks and velcro shoes, frowning at us with a pinched expression. It’s like a spiteful child picked a doll up by the face, stood her at the front door of the doll’s house, and got ready to shoot her with a BB gun.
‘What?’ she says.
‘Gemma! Hi there! My name is Magda and this is my colleague Jimmy. I’m so sorry to disturb you. We’re from the rapid response team and we’ve been asked to come see your husband, Bob. It’s lovely to meet you.’
‘I told them. I don’t want you people coming round no more.’
‘I know, I know. It’s problem. But we won’t be long, Gemma, I promise you. Just a hi and a bye kind of deal. Trust me. You’ll hardly know we were here.’
There’s a tense pause that the rumbling of a passing train does nothing to ease. I fully expect Gemma to slam the door, but Magda generously interprets the hesitation as an invitation, and starts moving forward. And really, when Magda starts walking forwards it’s very difficult to say no. So instead Gemma flattens herself to the wall, closes her eyes and lets us pass.
‘That’s very kind of you, Gemma. I appreciate that. Thank you very much, darling. Through here…?’
I follow Magda into the house. It’s tall and dark and watchful. A narrow hallway leads off to the kitchen out back, the sitting room to our left.
‘Bob!’ says Magda. ‘There you are! Hello mate!’

Bob is sitting behind the door in a high-backed chair, a zimmer frame to the right. He’s dressed in stripes, too, although his are blue like his eyes and easier to look at. Everything about him is the opposite to Gemma. They could be the figures in an emotional weather clock: Bob summer, Gemma winter.
‘Hello!’ he says, holding his arms left and right like he’s known her all his life. ‘What’s all this about, then?’
Magda explains who we are whilst I get my obs kit out. Bob is wearing shorts, so it’s immediately apparent to both of us that he has a wound on his leg.
‘What have you been up to, Bobby? How you hurt your leg like this?’
She bends down to look. Gemma, who up to this point has been sitting on the arm of a sofa like a storm on the horizon, suddenly springs up, hurries over, and clutches the zimmer frame with white knuckles.
‘You are not to look at that!’ she says. ‘I’m his wife! I take care of him!’
‘Well – yes – I understand this, Gemma, but you know we are here to see Bob. And to be honest with you, unless you have Power of Attorney…’
‘I DO have Power of Attorney!’
‘Great! That’s great! So now, of course, we need to see paperwork. You have paperwork, Gemma?’
Gemma gives a huff, releases the zimmer frame and stomps back to the sofa.
‘I’m his wife!’ she thunders. ‘I say what happens.’
Magda shrugs this off and chats to Bob whilst I clean and dress the wound. I want to take a photograph, but I’m conscious of Gemma staring at me and I think if I do the flash of it will tip her over the edge. She’ll probably snatch up that large, ceramic pelican and smash it over my head, Magda or no Magda. So I finish off with a set of obs – all of which are fine. I can feel the rumbling of her teeth grinding through the floorboards, although it might just be another train.
‘So tell me, Bobby? Tell me what happen with leg,’ says Magda.
‘I fell out of bed,’ he says, and then slowly, and irresistibly, he turns to look at his wife.

the guru comes back

It’s so hot it feels as if the sun has dropped in closer and burned away every last scrap of moisture. I’m okay though – waiting for the social worker in the shade of the tall privet hedge that marks out the perimeter of this estate. I don’t mind the wait. I stand with my bags at my feet, waving to the people coming and going along the driveway. The postman in his foraging cap with a strip of blue canvas hanging over his neck; the young couple striding out with a pram covered in netting; an elderly woman with her shades flipped up, her permed hair glinting metallically in the sun. It starts to feel strange, like I’ve been standing like this for years. When the postman comes out again I half expect him to come over and hand me a letter: To the Man by the Hedge. ‘Dear Standing Man…’

Liam the social worker hurries across the road, hugging a battered leather briefcase to his chest, looking right and left over his shoulder like he’s escaping with secrets and expects to be shot.

‘Phew! Sorry I’m late!’ he says, striding towards me over the lawn. ‘Have you made contact?’
‘No. I thought I’d better wait.’
‘Good. Good,’ he says, pushing back his long hair, the sweat standing out on his forehead. ‘Well, then. Shall we…?’

Nanette’s daughter Roo answers the door.
‘Thank you for coming,’ she says. ‘Although quite what you’ll be able to do I don’t know.’

It’s a difficult scenario. Nanette was discharged home after some disagreement amongst the clinicians about her mental capacity. Nanette has chronic health problems, made worse by a recent infection. Her history of taking medication is patchy to say the least; she prefers to take herbal remedies, to meditate and follow a strict dietary regime – all of which is fine, of course, except it’s reached the stage where it’s difficult to say whether the progress of the illness is affecting her ability to make rational decisions about her health. She was so unhappy and disruptive on the ward, the hospital took the view that on balance she’d be better off at home with the support of community health teams.

None of this would matter so much if Nanette wasn’t suffering, and putting herself at considerable risk.

‘She was outside last night in the early hours, knocking on random doors asking for ice cream,’ says Roo, taking a steadying breath. ‘I live miles away. I just can’t be here all the time.’

What makes it even harder is that Nanette won’t accept any care support. She’s been turning people away, shouting at them through the window, telling them to piss off, and worse. The self-neglect is starting to show now. I’ve been sent in with Liam to do as much of a review as she’ll tolerate, to see how she is and what more can be done short of sectioning.

We put on our masks and gloves and follow Roo up the stairs.

Nanette is sprawled on the sofa. Emaciated, a dump of stringy limbs loosely wrapped in a threadbare dressing gown. The tiny flat is super hot; the little fan turning its head ineffectually right and left and back again, like a sad little robot saying no, no, no.

‘Hello Nanette!’ says Liam, giving a little nod. ‘I’m Liam, a social worker, and this is Jim, a nursing assistant. We’ve come to see how you are.’

‘Well now you’ve seen me so you can piss off,’ she says.

‘We’ll go if you want us to, but first we’d like to see how things are and how we can help.’
‘You can see how they are,’ she says. ‘They’re hot.’
‘I know. It really is hot today,’ says Liam. ‘Would you mind if we sat down over here and had a quick chat. We won’t keep you long. Promise.’
She shrugs.
‘If you must,’ she says.

Roo fetches in two small, brightly coloured stools, the kinds of things you might find in an infant school. We sit with our knees up to our necks, and try to smile with our eyes over the rim of our masks.

‘Would you mind if I did your blood pressure and so on?’ I ask her.
She sighs.
‘I’m fine!’ she says. ‘Why is everyone so obsessed with blood pressure? This is what’s wrong with the world. Haven’t you got anything better to do?’
‘Not at the minute. We’re here for you.’
‘Well that’s nice,’ she says, not meaning it. ‘Go on then. But don’t pinch.’
I run through her obs, which are surprisingly good, considering.
‘Thank you!’ I say, sitting back down on the stool. ‘That’s all fine.’
‘I told you! You won’t listen. There’s nothing wrong with me. And if there is, I cope with it my own way…’
‘Who’s that in the photo?’ says Liam, nodding over to a large, gold-framed, hyper-colourised photo of an Indian man in yellow robes, a string of flowers round his neck. He’s holding his hands out, palms-up, smiling so widely his eyes are creased shut.
‘That’s my guru,’ says Nanette. ‘I followed him for years. He died a little while ago.’
‘I’m sorry to hear that,’ says Liam.
‘Dont’ be,’ says Nanette, painfully pushing herself up on her elbows. ‘See that other picture, there? The one to the right?’
In a silver frame. A shaky, grainy, long-distance shot of a young Indian guy in white robes, striding onto a stage in front of a huge audience.
‘He came back,’ she says.

two dwaynes

I’ve come to do Elaine’s assessment with Lisa, one of the physio assistants. Elaine is eighty, her cancer advancing rapidly towards end of life, to the point where she needs a great deal more equipment and care. The District Nurses want her to go into a hospice, because she has no family or friends to help out, she’s isolated and vulnerable where she is, and there’s a limit to what the various community health teams can do. Elaine doesn’t want to go, though, despite numerous falls and incidents. The DNs have referred her to us to see what else we can provide, including night sitters.

We’re told that Elaine is able to buzz us into the building with a remote device, but when we ring her number there’s no reply and nothing happens. The building manager isn’t in his office, so we push the emergency buzzer on the console. Because we don’t know the password, and the door’s not camera monitored, they won’t let us in. We ask if they’ll phone the hospital and check that way. It’s not part of their protocol, they say. They can’t do it.
‘She might be on the floor,’ says Lisa.
‘Sorry.’
They ring off.
Lisa curses, buzzes random flats. Eventually someone takes pity on us and lets us in.

Luckily, Elaine’s door is unlocked. She’s sitting on the floor leaning back against the bed. The only injury she has is a skin flap on her arm, so together we gently help her up again and settle her back in bed. I check her over and dress her wound.
The phone rings. Lisa answers on Elaine’s behalf.
‘It’s Dwayne,’ she says. ‘From the Salvation Army. He says he’ll call back later.’
Elaine nods, gently raising and then lowering her uninjured arm like a marionette sadly acknowledging some change in her surroundings, then she gently closes her eyes and rests her head back. She’s so frail and emaciated she hardly makes any impression on the pillow.
‘Dwayne is so sweet,’ she says. ‘There are two of them, you know.’
‘Two Dwaynes?’
‘Identical twins.’
‘Buy one get one free,’ says Lisa.

Gently holding the primary dressings in place, I wrap Elaine’s arm in a bandage.

‘I used to play tennis with this guy,’ I tell her. ‘It was only a year later I found out he had an identical twin. For some reason it just never came up. I went round to pick him up one day and when he came to the door I thought Whoa! What’s different? He just stood there looking at me whilst I tried to figure it out. Was he wearing new glasses? Has he cut his hair? What was it? After a while he said So I’m guessing Simon never told you he had an identical twin? It was so weird! They were the same but different. Very unsettling.’
‘I’ve not met Dwayne’s brother,’ says Elaine. ‘I’ve only ever seen pictures.’
‘What’s his name?’
‘Dwayne.’
‘What – they’re both called Dwayne?’
‘No. Dwayne’s called Dwayne. I don’t know what the other one’s called. Something or other, I expect.’
‘I was gonna say. If you had identical twins you wouldn’t call them both Dwayne. It’s confusing enough.’
‘I dunno,’ says Lisa. ‘Might make it easier.’

I tape the bandage.

‘There! Good as new!’
I gather all the rubbish together.
‘You know – it’s only recently I found out you can’t have identical twins of different genders,’ I say, peeling off my gloves, adding it to the waste bag, then putting it in the kitchen bin.
‘You can, actually,’ says Lisa. ‘It’s pretty rare, but it can happen. It’s all about the fertilisation. If you get two eggs developing in the uterus you get fraternal twins; if you get one egg that splits in two you get identical twins, boy boy or girl girl. But then sometimes one of the halves drops the Y chromosome and you get boy girl identical twins. Very rarely though. See what I mean?’
‘‘How do you know all this stuff?’
She winks and points.
‘Stick to the bandaging, Florence. Leave the science to me.’
Elaine tentatively flexes her bandaged arm.
‘Oh dear,’ she says. ‘I look like Boris Karloff.’
She sighs and closes her eyes again.
‘Maybe I had better think about that hospice,’ she says.