sad eyed lurcher of the lowlands

It was the dog that brought it back.

I had a sudden and vivid picture of the granddaughter’s English Lurcher, slowly lifting its head out of my bag when I went to fetch my steth. A mournful expression, like it had seen what I had in there and was profoundly disappointed.

As soon as I remembered the dog I had the whole scenario, in every detail: the carers who’d said Edie was off her legs and stuck in the chair; the GP who’d diagnosed an exacerbation of chronic shoulder pain, and prescribed stronger analgesia, referring Edie to us for physio, nursing, equipment, bridging care and whatever else we could think of; Edie herself, slumped over in a high-backed chair watching The Chase on TV; the granddaughter; the dog.

More than anything I remembered how successful the visit had been.

I’d met up with Jason for the double-up. Her obs had been fine, but because of her shoulder pain she’d struggled to push herself up from the chair. The longer she stayed scrunched up like that, the less likely she was to move, until she’d pretty much seized up completely. For a while it had looked as if Edie might have to go to hospital, but with patience, encouragement and some delicate handling, we’d managed to get Edie out of the chair and moving again. We’d put her to bed where she’d be able to rest in a more appropriate position, and mobilise more readily to a commode. It was all fine. The carers would be coming in as before. The stronger meds would ease things along, and a programme of physiotherapy would help Edie recover her strength and confidence. All in all, a very practical and successful intervention.

Which is why I couldn’t understand why Jason was talking about a complaint.

It had come from the daughter, who lived some miles away. Her view was that her mother should have been taken to hospital, or at the very least been given a bed in a rehab facility. According to the daughter we had failed in our duty of care. She had written to her MP. We had a day to write a statement.

‘It’s okay,’ said Jason with a shrug. ‘I don’t think the daughter really understands how things are with her mum. Who knows what the family dynamic is there? Maybe she heard stuck in chair and thought hospital? Never mind. It’ll be fine. We did the right thing.’

I felt aggrieved on Jason’s behalf. I’ve known him ever since I joined the team. An expert physio, he was friendly, positive, empathetic – in fact, a perfect example of what a community therapist should be. I could see him now, taking the whole situation in, crouching beside Edie, one hand on hers, patiently going over the options, how we could help, what we could try. No-one could have done more, and – I don’t think – could have produced such good results. All this at the end of a long and gruelling day. The injustice was crushing.

Jason slapped me on the shoulder and smiled.
‘Cheer up, Jim!’ he said. ‘You remind me of that dog!’

where you sleep

‘Anchored off Syracuse. Everyone fucker below deck drowned. Boom. Gone. That was a hard business. ‘Course – I was sleeping on top, so at least I had a chance. At least I could make a swim for it.’

Frankie’s eyes are so hooded, and the way the light is in the room, it’s almost as if he doesn’t have eyes at all. That, and his habit of moving his bottom jaw from side to side when he’s not talking, makes him seem like a statue chewing over the hard facts of his life.

‘Them kind of things mattered, where you slept and everything. I’ve always been a good sleeper. I could sleep upside down on a washing line. I used to sleep under the truck, so long as the ground was hard enough. Gave you a measure of protection. Here, they said. Frankie. Take these trucks up the coast for us. We drove from Port Said to Damascus. Had a whale of a time. We used to mix it up, course. Well – we was young, mate. We had nothing to lose. We knew we was basically cattled.’

He narrows his dark eyes at me and grinds his teeth.
‘D’you know what I mean? Cattled? That’s cockney slang, mate. Cattle trucked. Fucked.’
He laughs, settles back in the chair.

‘My missus was the brains of the operation. She was in the Waaf. There weren’t nothing she couldn’t do. Ride a motorbike. Shoot down a plane. Unscramble a secret message. I tell you what, I landed on my feet all right the day I met Junie.’

He grinds his teeth again and shifts his position in the chair.

‘She’s in a home now. I don’t see her all that much. Even when I do she don’t recognise me. That’s the dementia for you, mate. Still – I keep her bed made up. That way I reckon there’s a chance she might come back.’

buy one get one free

The new database was live, and the office was crammed with people – nurses, nursing co-ordinators, therapists of one sort or another, health care assistants, admin staff, pharmacists, and running around and over them all, a team of floor-walkers, problem solving, straightening things out, or trying to, like a team of super-motivated, superintendent, super-capable ants.

It felt good to get out.

* * *

Mr and Mrs Carter live in a cold little house at the bottom of a steep flight of concrete steps. Mrs Carter opens the door. A tall, grey, anxious woman in tracksuit bottoms and baggy black jumper, she greets me neutrally, as if I’m just the last in a long line of Things That Will Go On Happening.

She turns to walk unsteadily back into the bare sitting room, taking her seat by the heater that has just one bar on.
‘Cold today, isn’t it?’ I say, self-consciously setting up my laptop. ‘By the way. Apologies in advance. We’re using these things today. It’s all pretty new.’
‘Oh?’ she says.
‘God knows if I’ll get it right.’
‘Do your best,’ she says, folding her arms. ‘You can’t do more.’
‘No. That’s good advice. You can worry about these things too much.’
‘Yes,’ she says.

Mr Carter bursts through the door. He’s as tall and grey as his wife, but much more energised, with wavy white hair bursting from under his cap. He has one blue eye and one that’s completely filmed over, which intensifies his blustery bonhomie, somehow, and makes him look like some wild, superannuated robot just back from shopping.

‘Nearly fell over running for the bus,’ he says, dumping the bags, tearing off his cap and throwing it like a frisbee off into the corner. ‘That’ll be the next thing. There’ll be the two of us on your list. Buy one get one free.’

He glares and gapes at me, then strides over to the heater.
‘Let’s have this up,’ he says. ‘We’ll freeze otherwise.’
‘Thanks,’ I say, then tap enter to start the examination.
‘Fancy…’ says Mr Carter, nodding at the laptop, then throwing himself down onto the sofa next to me and pushing his fingers back through his hair. ‘The things you have these days.’
But I’m not sure if I’m on the right screen or not, and for a second I’m tempted to pick it up and throw it into the corner like Mr Carter’s cap.
‘Anyway,’ I say, turning to his wife. ‘Ignore all that. The most important thing is – how are you?’

bonnets vs aliens

Like a country that declares war on its neighbours over a mountain ridge, Mrs Alderman has gone to war over her back.

It’s been the cause of a great many problems and pain for her over the years, and lots of clinicians of one sort or another have been involved. But there are some degenerative diseases that can’t be cured with medication or fixed with surgery, and the best you can do is try to ease the symptoms and find a way of organising your life in a more accommodating way. Unfortunately, Mrs Alderman’s response has been to declare war on everyone who has tried to help. Top of her list are the orthopods, who – according to Mrs Alderman – are a bunch of clowns with chainsaws. The orthopods are followed by everyone else who works in the hospital, Consultant to Cleaner, then the ambulance service, Community health teams, doctors, their reception staff, and really anyone who happens to be driving past, and then her neighbours, of course, and most of all, her family.

Her grandson Joey has been staying with her a few days since this latest discharge from hospital. His main contribution has been to restock the fridge freezer with ready meals. Much further than that he’s unwilling to go, and it’s hard to blame him, really. The flat is an absolute mess, and even if you brought in a team to straighten the place out, Mrs Alderman would have it back in its current state before they’d posed for photos and shut the door behind them.

This sprawling sense of chaos and complaint seems to attach itself to any contact with Mrs Alderman. I’d been sent in to conduct the initial assessment, which is essentially a fact-finding mission, to see how she is and what she needs from us. We’d had a frank conversation about emergency care support, what she could and couldn’t do for herself. She’d agreed that one care call in the morning might be helpful to get her washed and dressed; everything else – taking her medication, putting a ready meal in the microwave – she could do for herself. She could get out the chair by herself and take her four-wheeled walker out of the flat, down the corridor and back, so she was by no means immobile. And it was important to take regular exercise, however limited.

What happens next is that Mrs Alderman is on the phone that evening complaining that the carers hadn’t shown up, that the morning carer had done nothing but stand in front of a photograph of a dog she used to own called Rusty saying how nice ginger dogs were, for fack’s sake, and then pulled off her support stockings and took them down to the laundry room.

‘They’re in the dryer,’ she says.
‘Who put them in the dryer for you?’
‘How the fack would I know?’
‘Can’t Joey fetch them up?’
‘Why should he? He’s seventeen! And anyway, even if he did he can’t put them on for me, can he? And I can’t. Not with my back. I thought you were supposed to be facking helping…’

The carer isn’t around to ask about any of this. My suspicion is that Mrs Alderman removed her own stockings and took them to the laundry room herself, but the Coordinator is worried.

‘It might be easiest if you just go there tonight and sort her out,’ she says. ‘And try to clarify the situation whilst you’re there.’

* * *

There’s just one person in the laundry room, an ancient woman bent over a broken plastic trug, busy shovelling the contents into a machine. She looks up when I come in, supporting herself on one arm so precariously she looks in imminent danger of pitching head-first into the washing machine.
‘Hello,’ I say. ‘I’m Jim, from the community health team at the hospital. I’ve just come to pick up Mrs Alderman’s washing and take it up to her. I think she left it in the dryer.’
The woman straightens.
‘Oh! She’s got you running around now, has she?’
I smile and shrug.
‘That’s her lot, there,’ she says, nodding at another plastic trug, piled up with dressing gowns and throws and things and two blue support stockings artfully draped on top.
‘She puts too much in’ says the woman, tightening the scarf round her head, then leaning back in to her load.

* * *

When I knock and struggle through into Mrs Alderman’s flat, the TV is on full volume. She’s watching a film – marines fighting alien invaders or something. A helicopter gets blown to bits and there’s a close up of Aaron Eckhart looking worried.
‘Put it down there,’ shouts Mrs Alderman to me, as if we were under fire, too, pointing the remote at an undifferentiated heap of crap in the middle of the room.
‘Fack me, I don’t know,’ she says, muting the TV. ‘One minute it’s Sense and Sensibility, the next it’s facking aliens.’

making faces at the fishes

Hans seems too full of life to be dying of cancer. With his bald head, handlebar moustache, fierce expression and thick wrists, all he needs is a leopard skin tunic and he’d be a cinch for a circus strongman. As things stand though Hans is confined to bed, his lungs corrupted with secondaries, metastasizing like acquisitive weeds from the seed pod of his liver. When Hans talks he has a curious habit of repeating certain phrases at double the volume, and sitting up a little at the same time. It’s a funny thing, like a verbal sneeze. I guess he’s done it all his life, because his wife June doesn’t seem to notice.
‘I cannot believe zis thing,’ he says, his German accent somehow adding to the strongman effect. ‘I cannot! Y’know? Listen. Just the other month I was swimming in the sea in Spain. In Spain! Making faces at all the little fishes there. Now look at me. Hopeless. Hopeless.’
June is putting a brave face on it, though – her and the family dog, Boney, a bichon frise made entirely of clouds, who sits by my bag and frowns anytime I take something out.
‘What do you make of it, Boney?’ she says, brightly.
‘Well – vat can the poor dog make of it?’ says Hans. ‘Apple pie? I say apple pie?

sea storm

The concrete marina wall does a pretty good job of protecting the boats from the worst of the weather. But when it’s as rough as it is today, there’s still enough of a swell pushing through the mouth of it to move them all restively up and down at their moorings, and for spouts of wild white water to jump up from time to time at different points, and fall back again in a spattering of foam.

Rita’s flat overlooks the marina. Watching the boats all move together like that, it’s easy to imagine this block is a boat, too, and we’re just waiting for a break in the weather before we open the patio doors, unfurl the tablecloth and set sail for someplace else.

I think Rita would settle for anyplace she could breathe more easily. She’s diagnosed with COPD and a history of infective exacerbations. For some reason this year’s been particularly bad, though, and she’s only just come out of hospital after a long stay with pneumonia. After I’ve finished the examination she sits in that characteristic way you often see with respiratory patients, inclined forwards with her back straight and her arms resting on her knees, to ease her breathing. She has a puffy, steroidal look, and her arms are bruised from countless needling.

‘What’s the verdict?’ she says. ‘And don’t you dare say hospital.’
‘We…ell’
‘Oh God. Here we go.’
‘It’s fifty-fifty whether you stay or go.’
‘In that case I’ll stay.’
I go over the facts and figures, the risks, the realities. She nods or shakes her head, depending, and when I’ve finished, gives her face a brisk rub with her hands.
‘It’s not as if you’re so bad I’m reaching for the phone while we speak,’ I tell her, trying to be as nonchalant as possible. ‘On the other hand…’
‘…on the other hand don’t start any long books.’
‘What I’d like to do is talk to your GP and see if they’ll come out and review the situation.’
‘Good luck with that. They never come out.’
‘I think they have to some times. It’s not as if you can go to them, is it? You get out of breath just standing up.’
‘You don’t know my GP. You’d have to be dying before they’d come out, and even then they’d probably just send a hearse.’
‘Let’s see what they say.’
I use Rita’s house phone. For some reason I haven’t got the bypass number for this surgery, so I opt to use the main number and take my turn like everyone else. I’m hanging on hold for some time, watching the boats riding up and down at their moorings.
‘I wouldn’t mind having a boat,’ I tell her, for something to say.
‘Yeah?’ she says. ‘Done much sailing, have you?’
‘Only once. I went sea fishing with a friend. I felt so seasick I wanted him to throw me overboard.’
‘The omens aren’t good then, are they?’
‘No. Not really. Although Nelson wasn’t supposed to be all that as a sailor. Y’know? Not in terms of defeating the French. I mean in terms of not throwing up.’
‘Yeah – but look what happened to him,’ says Rita.
‘You’re right. Maybe I’d be better off sticking to cars.’
‘Kiss me Hardy!’ She laughs, which immediately degrades into a thick and rumbly series of coughs, like a heavy storm massing in the distance. When it passes, she rubs her face again.
‘Mind you,’ she wheezes, ‘I think I know what he meant.’

smoko

There’s a small enclosed porch at the front of the house, and that’s where Karen goes to smoke, a bit like an air-lock in reverse. The porch only has three things in it (not including Karen): an ashtray, a pack of cigarettes and an enormous plastic pipette. Quite what that’s for I don’t know, but I don’t hang around to ask.

‘Dad’s in the kitchen having his porridge,’ says Karen, taking another deep drag and nodding behind her as she blows out.

Her father Keith is sitting at the kitchen table. A tall, lean man in his seventies, he struggles to his feet to shake my hand and thank me for coming. He’s had a long spell in hospital, discharged home with a summary of his complex health problems and a request to sort out equipment and therapy. His handshake is warm and firm, and despite his illness he still has an air of quiet competency about him.

‘Sorry about Karen’ he says. ‘She’s adopted the porch as her smoko and we can’t persuade her to stop. She’s got learning difficulties,’ he adds. ‘She’s a good girl.’

I set up shop at the table and we go over how things are and what Keith might need.

‘You wouldn’t think to look at me now but I used to be so fit,’ he says. ‘I played football, tennis. Swam in the sea. Built this house, worked full time. There weren’t enough hours in the day. And if you’d have said to me after all that I’d have ended up like this I’d never have believed you.’ He works the porridge around in his bowl a while then adds: ‘Never smoked. Not a one. Mind you – I think Karen’s taking care of that side of things all by herself.’
And as if summoned by her father, Karen strides into the kitchen, bringing with her a palpable cloak of smoke.

‘All right?’ she says.