locked away

It’s like the motorboat was dragged ashore some time ago to avoid a hurricane, and then forgotten.

The whole thing sits on two substantial wooden structures like trestle table legs. The deck is covered by a sagging, blue nylon tarpaulin secured by a single length of rope that crisscrosses from cleat to cleat like the threadbare lace of a giant boot, and the propeller is fixed in the up position, spotted, corroded. And if by some catastrophic tidal anomaly the boat suddenly found itself in the water again – and you found yourself in the water, too – and you tried to get on board using that aluminium ladder at the stern – well, who knows? You’ll try anything when you’re desperate. Scattered around the boat in the long grass are several heavy iron wrenches, lengths of rusting chain, and standing guard over the whole collection, a massive cylinder of pressurised gas the birds at least feel safe enough to use as a perch.

Judging by his beard, cable sweater and tan, I’m guessing it’s Henry who owns the boat. He’s so vague and repetitive, though, I have no doubt it wasn’t a hurricane that saw the boat laid up all those years ago, but a disturbance of a subtler though no less damaging kind.

‘Thank you so much for coming,’ he says. ‘It’s so kind of you to bother.’ He shows me inside to a wooden rocking chair, and then immediately asks again who I am and why I’ve come. Luckily, Henry’s wife, Jean hurries in, wiping her hands on her apron, her smile as taut as the tarpaulin on the boat.
‘Don’t you remember, darling? I told you. This is Jim, from the hospital. Come to see if we need any help.’
‘Well that’s so kind! Help, d’you say? I don’t think we do, though, do we Jean? I think we run a pretty tidy ship.’

Jean talks me through the key points of the referral. The long stay in hospital, the memory loss and other problems, the struggles of the last few years. And at every point in the story, she carefully includes her husband, who receives the information with a wistful expression, as if he’s hearing it all for the first time, the sad decline of a well-meaning but doomed mutual friend of theirs, someone he’d love to help if he could, but doesn’t know where to start.

One of my jobs today is to run a dementia blood screen. I chat to Henry as I locate the vein, taking his mind off the needle. He tells me he used to be a locksmith.
‘You’ll like this story then,’ I say. ‘Sharp scratch.’
‘Oh yes?’ he says.
‘I was brought up in a little market town called Wisbech. Out in the Fens.’
‘Yes?’ he says, as if it’s the most extraordinary thing he’s ever heard. ‘My goodness!’
‘I remember – years ago – there’s was a big fuss. They were renovating an old shop or something, and they found an old safe in the basement. Hadn’t been opened in years. So they got the local locksmith in, and HE couldn’t open it, because it was so old and fancy…’
‘Open what?’
‘This safe they found. In the basement.’
‘Goodness!’ says Henry. ‘Go on.’
‘But the locksmith knew this other locksmith who was an expert in old safes. And he came to have a look. And by this time it was quite an event. The local paper was there. Police. You name it. Because everyone wanted to know what they’d find when they finally managed to get it open.’
‘Well – fancy that!’ says Henry, flashing a look at Jean, standing in the kitchen doorway overseeing the whole thing.
‘So finally, after a lot of drilling and cutting and banging, they finally managed to crack the door and open it up. And you’ll never guess what they found inside.’
‘What?’ says Henry – commenting more on the fact I’ve stopped talking rather than anything to do with the safe.
‘Green shield stamps! Books and books of them!’
Jean laughs.
‘I remember them,’ she says. ‘You’d save forever and end up with a clothes brush.’
‘I suppose they were an early form of reward card,’ I say, withdrawing the needle from Henry’s arm and pressing down on the gauze for a minute or two. ‘There! All done!’
‘They used to have pink stamps, too,’ says Jean, taking her apron off and hanging it behind the door.
‘Did they? I don’t remember that!’
‘I do,’ says Henry.

a picture of aileen

‘I used to like doing puzzles until my hands got too bad and I couldn’t manage the pieces. Now I have to make do with giant sudoku.’
Aileen is sitting beneath a large colour studio photo of herself and husband Ian taken taken fifty years ago. Maybe Aileen is sitting there because of the light, or maybe it’s because she likes being as close as possible to an image of her life as it used to be. Whatever the reason, it would be difficult to imagine a harsher illustration of the effects of ageing. Portrait Aileen has a pile of golden hair banded at the cloudy peak with a tiara. She’s wearing a tartan skirt and sash, a silken blouse with ruffles, sparkling earrings and a pearl necklace. There’s a radiance to her that the blurry lens and the fancy drapes translates into something soapy but brilliant. Her husband Ian is just as enhanced, plump and red faced as a russet potato, packed into a kilt, waistcoat and bolero-jacket combination, medals and ribbons and pins, and one hand resting on Aileen’s shoulder, maintaining the transfer of power, one to the other. Real-time Aileen is somewhat reduced, of course. She’s sitting in a similarly demure posture, except now she’s in a fluffy blue dressing gown, the bouffant hair has collapsed into sparse threads of grey, and the rings on her fleshless hands hang loose.
‘We ran a restaurant together. For years – oh, way back,’ she says. ‘I loved it. Ian ran the kitchen side of things, I did the books. We both liked to entertain. Burns night we’d have the haggis piped in. You couldn’t wish for a better life. We had all kinds of celebrities. You wouldn’t have heard of them, of course. Then the lease got bought up by a city type, the rent doubled and we had to move on. Still – things change. No-one can help that.’
She coughs a few times. It sounds like someone shovelling rocks. When it passes, she settles herself again.
‘I get so terribly bored,’ she says. ‘Bored. Bored. Bored. Just sitting here.’
‘I bet. What about your family, though? Are they nearby?’
‘Not really,’ she says. ‘They’re spread about the place. They’ve got lives of their own.’
‘Here’s an idea,’ I tell her, warming to the theme. ‘Have you ever thought about putting your memories down? Writing about your grandparents, your mum and dad, that kind of thing? Not just the war – I mean how you and Ian met, all about the restaurant, who came in and out, what you got up to.’
‘I can’t hold a pen, love.’
‘You could get some kind of recording device. They’re pretty cheap these days. The thing is, I bet your grandchildren and great-grandchildren would love to read about these things, in a kind of family history way, with photos and everything. It’d be like one of your puzzles, only you’d be in all the pieces. It’s nice to know where you come from, how it all fits together. What do you think?’
Aileen is silent for a while.
‘No,’ she says at last. ‘Boring.’

smashing trucks

It’s a complex family situation – as they often are – but the long and the short of it is, Jimmy’s been sent home to die.

Although the end has come quickly, it’s not entirely unexpected. Jimmy has had an alcohol problem for a good many years, as punishing to his family life as his liver. Nothing helped, not counselling, drug and alcohol rehab, surgical corrections, medication – it all turned out to be a grave but ineffectual chorus singing downstage of the tragedy.

At least Jimmy still has people around him, though. In fact, the house is pretty full. There’s his brother, Tom, Tom’s wife Stella, Jimmy’s stepson Al and Al’s little boy, Kevin. Kevin is about three years old I’d guess, a cheeky, tow-haired kid in a dinosaur T and red shorts, loving the drama of all these people, showing off by diving onto the sofa, smashing his toy trucks together, sneaking up behind you, touching you on the shoulder and then running away screaming, bending over for no apparent reason and looking at you from upside down.
‘Kevin? Why don’t you settle down on the sofa and watch the Formula One?’ says Al, although I’d guess that’s really what he wants to do.
‘No!’ says Kevin, diving under the table.
‘Don’t worry, Al. I don’t mind,’ I say.
Al shrugs, and carries on unpacking the shopping.

It’s the first time I’ve met the family. Truth is, I’d been blindsided by the whole situation. I thought it’d be an easy call, dropping off equipment and doing some obs on a patient before returning to the hospital to take care of all the referrals that’d piled up that day. When I got there I’d found a patient who was actively dying, and insufficient preparation made for any of it. I couldn’t figure out how it could’ve happened like this. After I’d made Jimmy as comfortable as I could, cutting off his hospital gown with my shears to avoid disturbing him too much, giving him a stripwash on the bed and so on, all helped by Tom and Stella, I’d spoken to the office to confirm we were putting in double-up care that evening, then called Jimmy’s GP, who was as confused and disturbed as I was. She’d promised to get clarification from the hospital, and said she’d call straight back.
‘You’ve been so helpful,’ I say to Stella and Tom as they sit down with me at the table with some tea. ‘I’m sorry it’s been stressful and messed up.’
‘Don’t worry,’ she says. ‘These things happen. At least he’s not in pain.’
Tom puts his hand on Stella’s shoulder; she gives him a brave smile, then wraps both her hands round the mug of tea, to feel the warmth of it.
‘Our son Billy died this year,’ she says. ‘I suppose I’m getting used to it.’
‘I’m so sorry to hear that.’
‘I was with him at the end. He was struggling, so I put my arms round him to help him sit up. He was trying to say something, but he couldn’t get it out, and I couldn’t understand what it was. So I held him like that, and I said I loved him, and then he fell back, and that was that. And that was the start of the year.’
‘I’m just going to sit with Dad for a while,’ says Al, heading towards the stairs.
‘Okay then’ says Tom. ‘Good lad.’
‘Now you be good’ says Al to Kevin.
‘Look at my trucks!’ yells Kevin, bouncing up and down on the sofa, smashing the trucks together, head to head. Peeyow! Pow! Kapooooof!

a cat and a dog

a cat

Anna’s bed is in the bay window, the sunniest spot in the house, a light breeze filtering in through an open window, gently filling and turning the curtains. Anna’s asleep, curled up on her right side with one hand crooked under her head; sunlight illuminating the linen sheets and multi-coloured crochet square throw with such intensity it’s as if I’ve been staring at a beautiful painting for so long I’ve found myself suddenly transported into it.
Aside from the bed, the rest of the living room is just that – a room for living. There’s a baby lying on its back in a baby gym, reaching up for the fabric toys hanging overhead, waving his legs and gurgling happily; a toddler, standing on the sofa with her arms draped over the back, staring at me with wide, brown eyes; their mother, kneeling on the carpet, talking into the phone crooked at her neck whilst she folds laundry from the trug, and then her mother, Anna’s daughter Jean, standing in her dressing gown in the doorway, smiling, overseeing everything, cradling a mug of tea.
To add to it, a plump tabby cat strides into the room with her tail in the air. The toddler on the sofa jumps up a little, points to the cat, says Dat! and looks at me even more intensely.
The cat raises its chin like a butler in an over-starched collar, looks right and left, gives one, long, imperious yeowl, then collapses at my feet and stretches out, using her claws on the carpet to increase the bend, until she’s one languorous curve from the tip of her tail to her nose.
Dat! Dat! says the toddler, bouncing up and down on the sofa cushions.
‘Molly!’ says Jean, shaking her head and laughing.
And for a second, I’m not sure which is which.

a dog

Getting in to see James this morning was like trying to solve a giant, unwieldy puzzle. His carer Leila was delayed, some kind of bus trouble, apparently (We didn’t crash she said Thank God! But he is learner driver I think and he clipped mirrors and we all stopped for a long time and eventually I said no, no, no this is not good I have place to go so I asked them to let me be free please, and he did, and so then I ran and jumped on number 5, and change at river…). Meanwhile, Wendy the scheme manager wasn’t answering the intercom button or her phone. Two other residents had come outside already, one to smoke, one to chat. Both had asked if I wanted to go in and I’d said no, thanks, but James’ door is locked so it won’t do much good. They tell me where they saw Wendy last, and that segues into what a great job she does, and how the fish and chip supper went last night. It’s a nice block. Everyone looks out for everyone else, like a vertical village, people coming and going, or hanging around, mostly. Even the contractors working on the underground garage are cheerful and friendly, raising their coffee cups and smiling, more like actors than electricians, sauntering over from the on-location, TV catering wagon in their laundry fresh check shirts and utility belts.

The main door opens again and this time I see Wendy, waving her phone from the mezzanine floor that overlooks the lobby.
‘Can you come up here?’ she calls out to me. ‘Barry’ll let you in to see Jimmy. Sorry about the intercom. They’re working on it… or so they tell me!’
She says this on cue, just as the contractors are passing through the lobby. They smile and raise their coffee cups again, and exit stage right.

I go up – but I don’t have to wait long before Barry appears, an elderly man so immaculately turned-out I can imagine his Spotlight photo in the casting directory alongside the contractors.
‘This way,’ he says, jangling a bunch of keys and pressing the button for the lift. Then he turns and calls out ‘Fred! Come on, mate! We’ll go without you!’
‘Come on Fred!’ I say, then I turn to Barry and ask him who Fred is.
‘You haven’t met Fred?’
‘No.’
‘You’re in for a treat.’
We both turn to look at the archway that leads from the TV room out onto the mezzanine. I hear him before I see him, a deep, wet, resonantly lumpy sound, like an old British motorbike firing on one cylinder. Then I feel him – or I think I do – the thump of him through the springy floor. The lift arrives behind us, the door pings open but we both ignore it, waiting for Fred to emerge through the arch. And then he does – a gigantic black labrador, his tongue lolling out, hauling himself along on arthritic hips, one vast pad after the other, his head bobbing up and down with the effort of it all.
‘Come on, Fred!’ says Barry. ‘Good boy! Let’s go see Jimmy! Hey?’

the stone queen

There are warning signs tied to every lamppost: Road resurfacing. No parking. Tow-away zone. The silhouette of a truck dragging off a car, and a date scrawled in the space beneath. The date is tomorrow, though, so I figure I’ll probably be good to park here today. I’m prepared to take the risk. If I had to look for a parking space anywhere else I’d end up have to walk miles, and I’m behind on my visits as it is. I put my Parking Exemption ticket on the dashboard, grab my stuff and walk up the path to number 18.

Mina’s daughter, Sarah opens the door. She smiles bravely but looks exhausted, a fresh-looking perm accentuating the dark lines under her eyes, as if the energy it took to highlight and curl has used up whatever reserves she had left.

‘Mum’s upstairs,’ she says. ‘She hasn’t left the flat in a year or more – well, except for appointments.’

Despite the bright sunshine outside – or maybe because of it – the room is muted and still. There’s a large aquarium bubbling away against one wall, stunned fish drifting in and out of focus. The aquarium is so dominating, it seems to extend and occupy more than its own space, especially as the walls and the carpet are mottled green and blue, and all the furniture, too, soft and plump, making it feel like a state room on the Titanic, everything swollen with coral blooms. Mina is sitting in a scallop-backed armchair in the window, Queen of this Undersea World, except her robe of fish-scales is actually a fluffy blue dressing gown, and her trident is a walking stick.

I pull up a lobster, and ask how she’s feeling today.

She turns her sad eyes down on me, and with her knotty fingers draped over the handle of her stick, she sings me the sad, siren song of her back. A soft, sinking kind of song, as lulling as the bubbles. A song of osteoporosis, rheumatoid arthritis, COPD, heart failure, and diverticulitis. Of degenerative changes to lumbar vertebrae that can never be corrected. Certainly not by surgery; she wouldn’t survive the operation. All they can do is control her pain with medication. But she’s sensitive to just about everything, and they’re running out of ideas. She has all the equipment she needs. She knows the maisonette is inappropriate, as she can’t easily manage the stairs, but she’s lived there so long she couldn’t face moving – not that there’s anywhere to move to, bungalows being in such demand.

Sarah is sitting on the opposite chair, kneading her hands as she listens, as if she’s working through it by some invisible mechanism, forcing it to a conclusion. She interrupts when she can: I’ve got my own problems she says. Work. Kids. Everything else.

The questions I manage to ask have all been asked before. Mina deals with them all in turn, scarcely pausing to think, wrapping them up in words, kelp around a propeller.

‘Well – I’m limited to what I can do today,’ I say, shaking myself into action. ‘I’ll do your obs – you know – your blood pressure and so on, just to make sure there’s nothing else going on that might be making things worse, like an infection and so on. Take some blood, too. And then liaise with the GP. How does that sound?’

Mina smiles sadly, then turns her head towards the window.
‘They’re fixing the road tomorrow,’ she says, as I open my bag and set out my things.
‘I saw that! I didn’t know whether it was safe to park or not.’
‘It’s safe,’ she says. ‘I can see your car from here. The little blue one. If anyone goes near it I’ll use my stick and turn them to stone.’

And she taps it, once, on the carpet, to illustrate.

watertight

Glenda’s smile is so utilitarian I imagine she keeps it on a hook by the door.
‘Thank you so much for coming,’ she says – then waits in the hall for me to enter.
‘Shall I take my shoes off?’
‘Not many of your colleagues do.’
‘It’s what I do at home,’ I say. ‘It feels weird otherwise’
She watches as I slip them off and line them up with the others.
‘Easy on, easy off!’ I say, although the faux-Cockney falls flat.
Glenda watches me, one hand hooked over the other, a self-conscious and mechanical kind of coupling, like a robot that hasn’t had the soft skills upgrade.
‘What people don’t realise is the toxins they’re tracking through the house if they don’t take them off,’ she says.
‘No. Exactly. And anyway – I like the feel of a wooden floor under my socks. So…’
I wait for her to lead me through to her mother, the patient I’ve come to see, but Glenda stands absolutely still.
‘Take tarmac, for instance. They seal it with a cocktail of chemicals that are severely detrimental to one’s health. The sun comes out, the sealant becomes tacky, it adheres to the underside of the shoe, and you walk it in. Tests have shown the average household dust carries concentrations of harmful toxins such as PAH, which is implicated in respiratory and other illnesses.’
‘I bet.’
‘And then there are the bacteria, of course. E coli. C. diff. Klebsiella’
‘Yes.’
‘Not to mention all the debris and dirt you’d expect to find in the street and the garden.’
‘So – are you a microbiologist or something?’
She flinches.
‘No! I’m a lawyer’
‘Oh.’
I shoulder my bag in a resolute way that’s supposed to indicate I’m ready to move on.
‘You do understand the situation here,’ she says, after a significant pause.
‘Well – I think I do. The basics.’
‘Perhaps I’d better explain,’ she says. I adjust the weight of the bag on my shoulder.
‘My mother is ninety years old, a fully independent person who lives without assistance in a small village in Somerset called Duckton. She was on a visit to us when she became ill with a urinary tract infection, and suffered a minor injury fall, and was taken to hospital, where she spent three days. The hospital deemed her to be medically ready for discharge, on the understanding was that she should have one month of community rehabilitation, with therapy and nursing support, and care three times a day. Which is where you come in.’
‘Okay.’
‘There have been a number of medication changes effected at the hospital, and these have all been ratified by my own GP, who has taken temporary care of my mother whilst she is away from home.’
‘Great.’
‘Now. What I need from you – other than a medical review this morning – is to provide a report detailing all therapeutic programmes undertaken by your department, nursing interventions and so on, and for these to be communicated to my mother’s health authority in Somerset. I want assurances that all possible measures will be taken to maintain her safety when she returns home, provision of all necessary equipments and so on, and continuing care support from agencies in that county. Is that something you can help us with?’
Glenda talks in such a relentlessly steady way that it’s something of a lurch when she stops, like coming down a long flight of stairs and unexpectedly putting your foot down flat.
‘Well…erm… that’s not usually how it works.’
‘Explain to me how it usually works.’
I blush, and cast around for a friendly face. All I can find is a vast, frowning, butterscotch cat staring at me from the cushion of a Windsor chair. It looks so severe I wouldn’t be surprised to see it reach up and place a square of black cotton between its ears.
‘The thing is – Glenda,‘ I say, swallowing drily. ‘We’re an acute team. We get referrals from the doctor, the ambulance or the hospital, and we go in, and we make sure everything’s okay. Nursing, therapy, care or what have you. And when we’re done we refer back to the GP. Or make other referrals for chronic, longer-term needs, to the district nurses and others. And that’s about it.’
She sighs, once, heavily, as if she’d asked for architectural plans and been given sugar paper with a crayon sketch of a house.
‘It’s a question of resources,’ I say, helplessly. ‘A real world thing. We struggle to look after the people who live here, let alone the other side of the country.’
‘As I explained to you,’ she says at last. ‘I’m a lawyer. Now. A piece of paper with a signature on it constitutes a contract. And your service has contracted to provide us with one month of therapeutic, nursing and auxiliary care needs, prior to repatriation.’
‘Has it?’
‘Are you telling me this is not actually the case?’
I pick my bag up.
‘Glenda,’ I say.
She gives a small nod of her head, activating another, thinner smile.
‘I’ve come here this morning to see your mother. To see how she is, do her blood pressure and so on. I have an awful lot of other patients to see today, so I haven’t really got time to talk about the finer points of these things, much as I’d like to. So do you mind if we…?’
The smile flicks off again.
‘For example. If I was buying a boat,’ she says.
‘A boat?’
‘Yes. A boat. There are certain rules pertaining to the transaction that would need to be adhered to in order for that transaction to be properly concluded, to be watertight.’
An anguished voice calls out from the front room.
‘Who’s that at the door, Glenda? Is it the nurse?’
‘Coming!’ I say, shrugging, and holding up my hands. ‘Just losing the shoes…’

waving, and calling

The outside of the building has kept its elegant facade, and the cool black and white tiles of the hallway, the low-hanging chandelier and the multicoloured blaze of the leaded light window are about as perfect as you’d want for a Regency costume drama – so long as you were careful to keep the burnished steel lift out of shot.

The voice on the intercom was pretty direct.
Come inside, get in the lift, don’t touch the buttons.

I do as I’m told, and wait.
Nothing happens.
Did I hear her right? I can’t understand why I shouldn’t press anything. Maybe she thinks I’ll be confused by the mezzanine floors? Maybe when the place was converted into flats there was some architectural kink, and people are always getting lost. I can’t believe it, though. It all seems straightforward.
I wait some more – for what, I’m not sure.
Eventually the lift shudders and I start moving up.

Mrs Rouncewell is there to meet me.
‘Hello!’ I say, slipping off my shoes and then immediately wondering where to leave them.
‘Oh – you don’t have to do that,’ she says, obviously relieved that I have. I put them down as neatly as I can side-by-side beneath the enormous, floor to ceiling artwork that dominates the hallway. We both look at them a moment, in the confused and slightly disappointed way two people visiting an art gallery might look at something they’re not sure is an exhibit or littering.
‘So… what’s with the buttons?’ I say at last, as she leads me through to the lounge.
Mrs Rouncewell gives me a measured smile that I take to mean she’s explained this a few times before.
‘The lift opens directly out into the flat. You have to use a code to make it work, but that’s too difficult to explain over the intercom, so it’s easier just to say don’t touch the buttons.’
‘That explains it!’
‘It’s a security issue.’
‘Unusual.’
‘Unusual? In what way?’
‘Having a lift that opens directly into a flat. I’d never thought about that before.’
‘Yes. Well.’
She waits to see if there’s anything else, then leads me up a short staircase into a gigantic room that must be the footprint of the house, the furthest wall replaced by a panoramic plate glass window, a section of which stands open, revealing an immaculate rooftop garden, bistro table and chairs, and beyond the filigree railings at the edge, a wide city vista of houses and office blocks, all on a shining blue sky.

Her mother is lying in a riser-recliner chair, a halo of fine white hair ruffled by the breeze from the window. She looks comfortable, but her dementia has left her with a flushed and approximate look. She orientates herself to the change in the room like a newly-hatched chick.
‘Hello’ I say, putting my bag and folder down and offering my hand for her to shake. ‘Lovely to meet you.’
She reaches up and takes my hand – then suddenly cups it with both of hers, so strongly it’s quite a shock, and keeps it there, like she’s scared if I let go she’ll rise up and float off through the window, and see the two of us, her daughter and me, hurrying out onto the patio, waving from the railings as she trails helplessly away across the rooftops.
Calling out, maybe.
Waving, and calling.