raiders in the sky

Bill is sitting in his lounger, his black velcro support boot up on a stool, one hand draped over a walking stick. He’s watching an old British war film, Dirk Bogarde tapping a map of Europe with his swag stick, laying out the bad news with a ‘look here chaps’ and a ‘jolly decent of you old boy’ whilst the room of bomber crews heckle him respectfully and laugh heartily but fall silent just as quickly because anyone can see the whole thing looks like a bally serious show.
‘I’ve brought you that stuff!’ I say, struggling in with a perching stool, urinal bottle and pressure relieving cushion. ‘Happy Christmas!’
‘That’s very good of you!’ he says. ‘Where you’ll put it all, I don’t know.’
‘Well – the perching stool goes in the bathroom, you sit on the cushion, and the urinal sits by the bed.’
‘It’s not a big bathroom,’ he says. ‘But you’re welcome to have a look.’

He’s right about the bathroom. There’s just enough space to put the stool in front of the sink and still be able to open the door to get in. It’s a bleak but well-ordered room, one toothbrush and one shaver on a single glass shelf, a soap dish, a mirror, a towel. I experiment with a couple of positions, then leave the chair square on to the sink and go back into the living room.

The briefing has ended. Dirk Bogarde is having a chat with one of the lower ranks, a buck-toothed cockney sergeant who screws up his cap as he tells DB he’s married with six kids and how she’ll cope this Christmas without him he don’t know. Dirk Bogarde puts a hand on his shoulder and winces, which doesn’t bode well for the mission. But the cockney sergeant doesn’t seem to pick up on it, thankfully, and the sergeant and the scene move on.

‘See what you think,’ I say to Bill as I go back through. ‘I think you should still be able to get in and out alright. You and your leg.’
‘I’m grateful,’ he says. ‘Sorry to drag you out at Christmas.’
‘I was working anyway. It’s a pleasure. Ho ho ho.’
‘Yes,’ he says. ‘And a ho ho ho to you, too.’

Whilst I check Bill over for blood pressure, SATS and so on, the film cuts to a montage of mechanics putting the last touches to the Lancaster bombers, the crews clambering into the cockpits, going through their flight checks, calling out this and that, waving cheero, snapping on their masks.

‘Could be worse,’ I tell him, looping the stethoscope back round my neck.
‘What – my blood pressure?’
‘No. We could be at war. Anyway – your blood pressure’s fine, Bill. Better than mine.’
‘Is that right?’ he says. ‘Well. Something’s working, then.’
‘So how come you fell and broke your ankle? I didn’t get the full story.’
‘Me neither. One minute I was getting out of bed, the next I was lying on the floor with my leg twisted under me.’
‘What did the doctors say about it at the hospital?’
‘I don’t know. And I didn’t care to ask.’
‘Oh? Why not?’
‘Well. They might turn round and tell me.’
‘That’s true enough.’

We both look at the TV. The bombers are leaving, one after the other, a flock of monstrous black birds roaring off into the night.

‘Lock the door on your way out,’ says Bill.

the great conjunction

Saturn and Jupiter are lining up.

Apparently it’s a thing that happens every twenty years, but a great conjunction, where the two planets get so close they look like a single bright star – well, that only happens every four hundred years or so. Kepler, the seventeenth century astronomer, pointed out that a great conjunction happened in 7 BCE, and may account for the Star of Bethlehem in The Nativity.

Today we’ve had nothing but thick fog and a cruel variety of fine, saturating rain that makes walking forwards feel like swimming up. It was just as well the weather was kinder all those years ago in Bethlehem, otherwise the Birth of Christ would have featured a comedy moment where three bedraggled kings holding fancy boxes over their heads high-step three hours late into an empty stable where an innkeeper is sweeping up.

Two thousand years back in the CE, though, Saturn and Jupiter aren’t the only things lining up.

Karen, the physio, is waiting for us under the porch outside Mr and Mrs Billingham’s house. She’s brought a walking stick. Jack the carer is here for a lunchtime call. I’ve turned up to deliver and fit a shower stool and a toilet frame, and to do some obs. There’s not much room under the porch, so I’m at the bottom of the steps leaning in.
‘I’ve rung the bell but nothing’s happening,’ says Karen, her eyes smiling above her mask. ‘I’m not even sure it’s working.’
‘Shall I knock?’ says Jack. He goes up to the door – an iron-bounded oak affair, with a door knocker so huge it wouldn’t look out of place on a quayside with a ship tied up to it – and flips it three times.
‘It’s like Jack and the Beanstalk,’ I say. ‘When he goes up to the castle and knocks.’
‘Have you met Mr Billingham?’ says Jack. ‘I don’t think ogre is far off, as it goes.’
We wait.
The house is silent.
‘Are they in?’
‘They don’t go out.’
‘Do you think they’re in?’
‘Hang on…’ says Karen, leaning into the door. We all listen.
‘No. Sorry,’ she says, straightening up again. ‘I thought I heard something.’
Jack sighs.
‘This is ridiculous,’ he says. ‘We keep coming back, and the same thing keeps happening.’
‘He’d better hurry up,’ I say. ‘I’m worried about this shower stool getting wet.’
They both laugh.
‘Actually – aren’t they designed to get wet?’ says Karen.
Jack gets his phone out.
‘I’ll ring him.’
Amazingly, Mrs Billingham picks up almost immediately. Karen and I only hear half of the conversation, but this is roughly how it goes.
‘… we’ve come to see how you are, Joan…. because the doctor asked us to…. you had that fall, didn’t you? And people were worried… well… Joan… actually it isn’t that early. It’s lunchtime, Joan… that’s why I’m here, to help you get something to eat and whatnot… and I’ve got some other people here to see you, too… colleagues of mine… well, there’s Karen, the physio, she’s here to help you get back on your feet… and there’s Jim, the nursing assistant to make sure you’re okay, and to put in some equipment to help with this and that… we talked about it the other day, d’you remember?…. yep… yep… but Joan… yep… yep… Joan?… the thing is, we really need to see you today… no, the phone doesn’t really count… we need to clap eyes on you, to make sure everything’s okay… yep… sure, put him on….’
Jack widens his eyes at us and breathes out heavily, which immediately steams up his glasses. Then Mr Billingham comes to the phone and Jack starts up again:
‘…hello ….Mr Billingham? …. it’s Jack, the carer. Hi! We met the other day? How are you?… yep… and I’m sorry to disturb you… well – I did phone ahead, but the phone cut out… no, a few times…. yep… I appreciate that… yep… I know you’re in bed… but the thing is, Mr Billingham, we really need to see Joan… because the GP asked us to… he’s worried, Mr Billingham… yep… yep… I understand that… but the thing is, Mr Billingham – with the greatest respect – Joan is our patient. She’s our responsibility. And that’s why we need to see her for ourselves….’

The conversation carries on like this for some time. He persists long after I would’ve given up, and I’m impressed with Jack’s patience. He doesn’t raise his voice or start to sound hectoring or patronising at all. Instead, like some accomplished hostage negotiator, he makes subtle changes of argument, trying to coax Mr Billingham downstairs to unlock the front door and let us in.

Meanwhile, more people have started to arrive. Two representatives of the care agency who’ve come to do their initial assessment. They’re bulky, approximate figures, swathed in enormous parka coats, the furry hoods up, tightly clutching blue folders to them like aliens holding manuals to life on Earth. Next is another figure in a smaller but still pretty substantial shiny black puffa jacket, with some kind of Norwegian hat pulled hard down over her head, the ear flaps resting on her shoulders. When I nod and smile at her she just sways a little from side to side and bobs at the knee. I get the impression she’s a social worker. Last to join the line is a postman. He’s like the Royal Mail version of Lear on the heath, his long grey hair completely soaked and bedraggled, his beard, too. All he has on are a lightweight jacket and cargo shorts, none of which would be any good on a summer’s evening, let alone the current horror show. He’s weighed down by an enormous mail sack, of course – but he seems remarkably chipper.
‘What’s up?’ he says from the back of the queue. ‘Are they having a sale or something?’
Before anyone can answer he taps the social worker on the back.
‘Here ya go, Pingu,’ he says. ‘Pass these along and stuff ‘em in the box, would ya?’
Then he waves and marches off.
The letters make their way forward. I hand them to Karen, she hands them to Jack, who – still talking on the phone and cradling it to his ear – pushes them through the letterbox.
‘Mr Billingham! Your mail’s arrived!’ he says as he does it. ‘Some exciting looking envelopes… cards and all sorts … why don’t you nip down and have a look…?’

the test

I had an appointment for a swab at the Walk-in Covid Testing Station at the local park. I’d developed a cough, and although I had no other symptoms and felt quite well, still, I needed to have confirmation I wasn’t infected.

It was around five o’clock. Temporary floodlights brutally illuminated a series of chain link safety fences; two walkways of interlinked boards that led into a gap marked ENTRANCE and then out of one marked EXIT; a white portakabin,and then the big, white marquee beyond. It looked like some kind of festival, except – a particularly bleak and sinister one, held at night, where you’re the only guest. There was a Covid marshall in a visor and surgical mask, hi-vis tabard, beanie hat and boots, stamping and rocking from side to side, blowing into his cupped hands.
‘Alright?’ I said as I approached.
‘Blinding!’ he said.
He made a gesture with his right hand, the cliche kind of thing you see in spy films when the tough border guard demands to see your papers. I showed him my phone, and the thing I’d downloaded from the government site. He scanned it.
‘Go on, then,’ he said. ‘Knock yourself out.’ Then holstered his scanner, and carried on stamping.

I followed the walkway through the fence and the rolled-back flaps of the marquee. There was a test official waiting for me by a camping table laid out with sealed packets and things. He was friendlier than the door guy, but I thought that was only because he was standing by a patio heater.
‘Hello!’ he said, beaming behind his visor. ‘Can I see your appointment code again, please?’
I showed him the phone.
‘That’s great!’ he said. ‘Lovely!’ And handed me a pack.
‘Just find yourself a cubicle and follow the instructions,’ he said. ‘I’ll pop in and see you’ve got everything you need and know what to do. Okay? Great!’

The marquee had been divided into thirds by two huge sections of canvas running the length of the space. The middle third was left clear – just a stretch of grass and the metal walkway down the centre; the remaining thirds were subdivided horizontally into cubicles by smaller canvases. There was clear plastic at the entrance to each, like windows. I went into the nearest empty cubicle, although – to be fair – I could’ve used any of them, because the place seemed pretty empty.

I sat down at the camping table they’d set up for the test, put my pack in front of me, and started to read the instructions. The test official hooked back the flap of my cubicle and looked in.
‘Alright?’ he said. ‘Got everything you need?’
‘Yep. It all seems pretty straighforward. Anyway – I’ve done it before.’
‘Oh?’ he said. ‘Experienced!’
‘Yeah. A drive-in place.’
‘Really?’ he said – but that’s as far as it went. There didn’t seem an awful more to say about it. To fill the dead air, I suppose, I said the first thing that came to mind.
‘I wasn’t sure about the app,’ I said.
‘Oh? Why?’
‘When I used the Q Code it took me to a strange place.’
‘What strange place?’
‘Oh – some website. I don’t know what it was. Lots of links and things.’
He widened his eyes above his mask.
‘Mmm!’ he said. ‘Where do you think THEY led to?’
‘I don’t know,’ I said. ‘Somewhere amazing, probably.’
‘Well!’ said the official. ‘Maybe next time you should click.’
‘Maybe I should.’
He stayed there a second more, kind of swinging on the flap. Then he straightened up and pointed at me.
‘Shout if you need anything!’
‘Will do!’ I said, trying to match his energy but blushing instead.
He left.

I opened the packet and lay out the kit, cleaned my hands with the alcohol gel, and got ready to swab my throat and nose. There was a little round hand mirror on the table, so I used that.

In my own defence, I think the cough had sensitised my throat. I mean – last time I did the swab I retched a little. It’s not a great feeling at the best of time, paddling a giant cotton bud around at the back of your throat. Today, though, was especially difficult.

I made such a fuss about it the guy came back.
‘What on EARTH is going on?’ he said, swinging on the flap again. ‘We’ve had some gaggers in today but you’re the absolute WORST!’
‘Sorry!’ I gasped. ‘I’m finding it hard today.’
‘You certainly are!’ he said. ‘You sound like a cat with a hairball. You sure you’re okay?’
‘Yeah. I’ll be fine.’
‘Well – alright then. But you be careful what you put down there. And see me when you’re done.’

The nose was easy after the throat. I shoved the business end of the swab into the phial of liquid, snapped it off, screwed on the lid, put one thing inside another in the way the instructions directed, then cleared up my station and left the cubicle.

The test official was there, waiting.
‘This way!’ he said, and I followed him down the bouncing metal walkway to another long camping table, this one set up in front of a larger cubicle with a clear plastic hatch.
‘Another customer for you, Malcolm!’ he said, leaning on the table. Malcolm didn’t seem enthusiastic, though. He was waiting just the other side of the hatch, so motionless he could’ve been a mannequin dressed in PPE, there to make the place look busier. But then he moved, and asked me in a bored voice to hold up my pack so he could scan it. After the beep he pushed open the flap for me to drop the pack into the bin the other side. I wondered whether they swapped jobs from time to time, just to liven things up, but I didn’t feel able to ask.
‘Thanks so much!’ I said, as if they’d just treated me to an amazing dinner.
‘You’re VERY welcome!’ said the test official. ‘And DON’T go following any strange numbers!’

I left the marquee, following the boards, eventually leaving parallel to the ones I’d used to enter the place. The marshall was still there, doing his wintery, side-to-side shuffle. He was right under the halogen scene lights, picked out like an actor on stage. It would’ve been great to see him launch into a Kung Fu routine. But he didn’t.
I waved to him; he nodded back.
‘Have a good night!’ I said.
‘You’re kidding, right?’ he said.
I shrugged, shoved my hands my hands deep in my pockets, headed for the car.

return of the pedalo kid

I’ve been coordinating all day. Which isn’t a plea for special consideration, more just a recognition of a physical fact, like admitting the Atlantic is pretty big, or yes, on balance, it’s probably true, the Himalayas can be bumpy. I’ve been shackled to the galley of this desk, working the keyboard and the phones, from half past seven in the morning, with everyone breezing in bright and fresh and grabbing coffee, to seven in the evening, most of the crew gone, the dishwasher churning in the background, the motion sensitive lights starting to click off, and a radio playing Christmas songs on a loop in the background Twas Christmas Eve babe…in the drunk tank…. There are only a few of us left now, the stragglers, the no-hopers, the hangers-on, the lost. One of the latter, Will, is a new physio, struggling to finish his paperwork. I’ve helped him out with bits and pieces, but he still has a way to go. He keeps coming up to the desk, holding his laptop in the flat of his hands like he’s offering up a bird with a broken wing that he doesn’t think can be saved.

I’ve been wearing a mask all day, too, which doesn’t help. It’s like having your head under the duvet, which – after eleven hours of coordinating – is a dangerous state of affairs.
‘That last call took me way longer than I expected,’ says Will, approaching the desk with his laptop again.
‘It’s tricky, to begin with. There’s a lot to think about. You’ll get quicker.’
‘Yeah. Also….the family were quite challenging.’
‘Were they? In what way?’
‘Oh – he was alright. It was his wife. Mrs Tuttle. She was quite hostile. I don’t think she wanted me there.’
‘Let’s take a look…’
I call the patient’s records up.
‘Hmm. It says here the last time he was on our books, about six months ago, we had trouble getting access. Looks like she didn’t want anyone coming in the house. Concerns about Mr T. Social workers … dah, dah … yep, definitely sounds tricky. We’ll have to go carefully. I think you did an amazing job to get as far as you did, Will.’
‘Thanks,’ he says. ‘I took it slow. Which I had to do anyway. It’s just…’
‘Go on..’
‘You couldn’t call her, could you?’
‘Who? Mrs Tuttle. Of course! What for?’
‘Well – I had to get out of there pretty sharpish in the end, and I wasn’t sure she really understood about the way it works with the carers.’
‘I can explain it to her. No worries.’
‘Thanks. lt’s things like letting her know that they can’t ring before they turn up. Also that they’ll be respectful about waiting before entering the house. And the kind of things they’ll do when they go in.’
‘Absolutely. I can do that.’
‘Thanks!’ he says, looking relieved. ‘I don’t think I could face talking to her again.’
‘How bad could she be?’
He smiles at me, then slowly backs away.

I have to admit, helping Will like this feels good. It makes me feel like an old hand. I’ve visited so many patients now, in the ambulance and in the hospital avoidance team. I’ve seen it all, good and bad. I see myself as Will no doubt sees me – one of those helpful, easy-going, thoroughly competent colleagues who’ll always be there to pour oil on troubled waters. I sigh, lean back in the chair. Pick the phone up. Hang the mask off my ear like a marine. Check the number. Punch it out.
When the phone picks up I introduce myself.
‘Why are you ringing?’ says Mrs Tuttle. ‘The other man was only here five minutes ago.’
There’s a formidable clip to her voice that immediately registers. I feel like I’ve put to sea drunk in a swan-shaped pedalo and woken up five miles offshore. In the rain.
‘Yes. I know. That was Will. The Occupational Therapist.’
‘Oh! Well. He told me he was a Physiotherapist.’
‘Yes! You’re right! Sorry. That’s what I meant. Physiotherapist.’
I want to tell her that he’s only just started here and I was momentarily confused, but the words burn away just as surely and instantaneously as my sang froid.
‘It’s just like the hospital,’ she carries on. ‘They tell you one thing and do something completely different. They say my husband won’t be coming out for a week and then five minutes later I’m called by the ambulance to say he’s on his way. They promise the earth and give you nothing. And now you.’
‘Well. Yes. It must be frustrating.’
‘Frustrating?’ she says. ‘Would you mind waiting there a second?’
‘Of course.’
‘I’m just going to put on the recording device.’
‘Absolutely.’
Recording device.
‘There!’ she says. ‘Now. Start again please. Tell me your name, your job description, and the purpose of your call.’

a second set of clothes

‘They said there’s nothing more they can do for Jean. They said it’s terminal. Do you think that’s right? Do you think there’s anything more to be done?’
Stan’s eyes bore into me. There’s a slack and waxy look to his face, like he hasn’t slept for a week.
‘I don’t know, Stan,’ I tell him, and look down again at the discharge summary in my hands. The journey Jean has taken from ambulance admission to A and E and then back again is described in lean, jargonistic language, but no less damning for all that.
‘What did they say at the hospital?’
‘Not much. But then a doctor came round here the day after Jean came home and said that was it, basically.’
‘It’s so hard,’ I say. ‘How are you bearing up?’
He massages one fleshy hand with the other, working the thumb into the palm, like he only needed to get a little strength back there and he’d be able to do something, to make some change.
‘I’m used to sorting things out, getting things done,’ he says. ‘I’m the one they all came to. I even organised the skiing trips. But this? I just don’t know. I just don’t know.’
‘Do you have family around, Stan? Friends, neighbours?’
‘We didn’t have children,’ he says. ‘Not that it bothered us, after a while. We had Jean’s family, our friends, of course. They’re all elderly, now. Half of them are dead. I think I’m the only man left amongst the old lot. So – what do you think? What should I do?’
I lay the discharge summary gently on the table, beside the DNACPR and the scrip for the anticipatory meds.
‘You know – just reading what the medics have written here, it does look like Jean’s cancer is untreatable. So the thing is to take care of her at home now, if that’s what you both want. It’ll be about symptom control, making Jean comfortable. Have the palliative team been round yet?’
He nods.
‘There’s been a lot of people in and out.’
‘It gets confusing. Whoever comes in should write in the folder here – who they are and what they’ve done – so there’s that. And there’s a list of the main numbers to ring if anything changes or you’ve got any questions. I’ll give the palliative team a call in a minute and ask where we are with visits and things. What to expect next.’
‘They left all these medicines. What am I supposed to do with them?’
‘Those are what they call the Just in Case meds. It’s things for pain relief, to help Jean’s breathing, anti-nausea meds, that sort of thing. You don’t have to worry about them, Stan. The District Nurses will be in to take care of all that. Is that okay?’
‘I suppose it’ll have to be.’
‘They’ve referred Jean to us for some urgent equipment and care support.’
‘Right. Got you.’
I wait a minute, then stand up.
‘What d’you think? Shall we go up and say hello to Jean?’
‘Yes. Sorry,’ he says. ‘It’s funny. She’s normally up with the lark, but she’s feeling pretty worn out so she’s staying in bed.’
‘I don’t blame her.’

He leads me up a narrow, carpeted staircase, worn to the thread in the middle, the boards sagging and creaking. The landing window is open and an unseasonably warm afternoon breeze nudges through the curtain.
‘Jean?’ says Stan, as we go into the bedroom where Jean is propped up on four pillows. She’s breathing quickly, her cheeks flushed and her lips pursed, with the rapt expression you sometimes see on patients who are riding their discomfort and don’t have room for anything else.
‘Hello, Jean!’ I say, waving. ‘Shall we sit you up a bit? It’ll help with your breathing.’
Once she’s more upright her breathing does ease a little, and her oxygen levels are surprisingly good. Despite her wasted condition, she still manages to tease me. Stan sits in the wicker chair beside the bed, and starts kneading his hands again.

‘I’ll need to make a quick call to the palliative team,’ I say to them. ‘Is that okay?’
Jean squeezes my hand.
‘You do what you have to do,’ says Stan.
I step away from the bed to make room for him, then make the call standing at the bottom of the bed, using the duvet as a desk for the open folder, which Jean moves with a cheeky nudge of her foot.

Luckily, Sandy answers the phone. Sandy’s a palliative nurse I’ve never met in real life but who always exudes great competence and compassion.
‘We’ll send a nurse out in an hour,’ she says. ‘Meanwhile, have a scootch around and see what you can do in the way of equipment. And start the care as soon as you can.’

‘I think you’ll really feel the benefit of a hospital bed,’ I tell Jean, putting the phone back in my pocket. ‘They’re fantastic, these beds. You can adjust the height, sit the back up – all sorts. All at the touch of a button. The pressure mattress is nice and comfortable, and means you’ll be less likely to get a pressure sore. We can get it installed pretty quick. All we need to decide is where it goes. We’ll need to clear space for it.’
‘I’ll show you the second bedroom,’ says Stan. He gives Jean a kiss then takes me next door.

The second bedroom is half the size of the first, with a single bed in the centre, a wardrobe in the corner and not much else. I’d guess it was the room Stan’s been sleeping in, although you’d hardly know it. There’s a shirt, a pair of trousers, a pair of pants and a pair of socks neatly laid out on the bed, side by side. They look exactly like the clothes he’s got on already.
‘This is great!’ I say, looking around, but not moving. ‘Plenty of room for the hospital bed once this one’s gone. A nice view of the garden. Lovely! What do you think you’ll do with this bed?’
‘I’ll just stand it on its end in the corner by the wardrobe. Maybe throw a sheet over it.’
‘Do you want a hand to do it?’
‘Me? No,’ he says. ‘That’s one thing I’m still good for.’
And we both stand there, side by side, staring at the clothes on the bed, like we fully expect them to magically jump up, throw themselves together and start flying round the room.
‘I’ll make the order,’ I say.
‘Stanley?’ cries Jean.
‘Yes, love…’ he says, and hurries back.

read my lips

Mr Blatchford is a double-up for two reasons. The first is manual-handling: he’s a bed-bound, double-amputee, so he needs two people to log-roll in situ for personal care and wound dressing, and for repositioning in the bed. The other reason is he’s aggressive.
‘It sounds like a suit of armour job,’ says Rosa, the coordinator today. ‘Long sleeved gown, mask and visor, gloves of course. Shoe covers, probably.’
‘Because he’s aggressive?’
‘No. Because he spits.’
‘Spits?’
‘Yes. Spits. Intentionally. Not just when he’s talking.’
‘Has he got dementia or something?’
‘No. He’s just spitty. And sweary. Sorry.’
‘You’re not selling him.’
‘I’m not, am I? Still – he shouldn’t be with us long.’
‘Let’s hope not.’
‘You’ll have to double-up with his usual carer, Mandy this morning. When she’s not there we’ll have to find another pair of hands.’

I know the block well – a warden-controlled place on the outskirts of town. The kind of prefabricated, glass and red-brick building you could throw up in an afternoon if you knew your way round a box of Lego. Mandy meets me at the front door. She seems thoroughly pleasant, which is encouraging.
‘Dickie’s so happy to be home,’ she says, showing me up the main stairs. ‘He’s got all the equipment he needs, so we’re pretty well set-up.’
She gives me a hesitant, backwards glance over her shoulder.
‘What have they … said about him?’
‘They said he was a bit of a handful,’ I tell her. ‘They said he spits.’
She stops on the landing with one hand on the fire door.
‘They’ve said a lot of things about Dickie,’ she says. ‘To be honest with you, I don’t know where it’s come from. I mean – it’s true – he can be plain-spoken. He’s always been a bit fruity with his language. And I think it’s true his mental state has taken a bit of a dip. But this spitting business? I’ve not seen it. Treat him as you find him, of course, but don’t worry about the spitting too much. I think it might’ve got a bit blown out of proportion.’
‘I’ll still gown-up in the corridor, though, if that’s okay.’
‘You do what you have to,’ she says. ‘I’ll go on in and tell him you’re here.’

Dickie is an elderly guy in the last weeks of his life. He’s lying on his back in a hospital bed, the covers tucked neatly up to his chin. The flesh has fallen away from his nose and cheeks and his grey hair is combed back in gelled lines. A pair of enormous steel-rimmed glasses are balanced on the ridge of his nose which magnify his eyes and – with his mouth half-open – give him the appearance of an ancient fish, unexpectedly landed, salted away in a box.
‘It’s the nurse, Dickie,’ says Mandy, gently laying a hand on the covers. ‘Come to see how you are.’
He moves his lips up and down in an approximate way. Mandy smiles up at me.
‘Dickie has trouble speaking,’ she says. ‘But he does make sense if you concentrate.’
I move closer to the bed and lean over, my apron rustling, my visor fogging up.
‘Hello, Dickie,’ I say, speaking loudly to be heard through everything. ‘My name’s Jim. I’m a nursing assistant. Welcome home!’
He turns his head to look at me, and his mouth waggles.
‘What’s that?’ I say. ‘I can’t quite get it.’
‘He says Can you lip read?’ says Mandy. ‘It’s okay. I’ve known him a long time. I’m quite good at it.’
‘I’ll have a go!’ I say, leaning in a bit closer.
He waggles his mouth again.
‘Nope. Sorry. Can you say it again?’
‘Oh, Dickie…’ says Mandy.
‘Once more…?’ I say, leaning in even more closely, frowning, staring at his mouth. The bottom teeth biting the upper lip and then releasing in a tired flick; the lips dropping into something of an O; the bottom teeth touching the upper lip again, releasing more softly.
‘Oh. Okay. Yep. Got it that time.’
Fuck off.
‘He doesn’t mean it,’ says Mandy. ‘Do you, Dickie?’
Dickie slowly turns his head to look at her, and his gnarly old eyebrows quiver – as best they can – into the up position.

avatar vs aliens

John is sitting cross-legged on the floor playing an Xbox game. On the giant plasma screen in front of him are two weird aliens, standing on a barren planet that’s being bombarded with rocks and space junk. Both aliens are about the same except one’s fluorescent blue and the other green. They look like huge, organic, see-through machines, waving delicate antennae, flexing toothy mouths. Spooky electronic music plays on a loop.

‘Alright?’ says John, glancing up as I come in, then moving his spaceman avatar a little closer to the aliens.

John’s an amiable drunk. His alcohol consumption has moved into that cirrhotic purgatory where he needs a certain quantity just to maintain basic function. Quite how he got to that point – and, crucially, how he’ll get out of it – are questions John will have to work through himself along with the support workers from the substance abuse team. For now, we’ve been referred in to help him with any equipment and therapy that might help.

‘This is my spaceship,’ he says, putting the controller to one side and leaning back against the vast futon behind him. ‘Whaddya think? Double king size. And the good news is – I can just crawl in.’

Crawling is how John gets about, mostly, or a strange, insectivorous variation. His legs are terribly deconditioned, fixed in a lotus position from long years on the floor. He reminds me of a magazine article I read once about an Indian sadhu in Delhi who lived forty years or more with his right arm held straight up in the air to distract him from the luxuries of normal life or something. An act of devotion, anyway.

‘They didn’t know what to do with me in the hospital,’ says John, smiling. ‘They wanted me to stay in bed, but I weren’t having none of it. So I tried to escape. ‘Course – they was all waiting for me in the corridor, the nurses, the security people, all standing there with their arms folded. I said to them Oi Oi! What’ve we got here, then? The Gestapo? But they didn’t wanna know. They just dragged me back to bed. And here we are. I suppose you want to do my blood pressure and all that. I think you’ll find it’s in order.’

I run through the obs, one eye on the sphyg gauge, the other on the weird, winnowy aliens on the screen. It feels like they’re hanging back, waiting for me to finish before they attack again.

I unwrap the cuff and take the steth buds out of my ears.
‘How’m I doin’ then, doc?’ he says.
‘Fine. Your blood pressure’s better than mine.’
He laughs.
‘I like that! Better’n yours!’
Then he nods and narrows his eyes.
‘How old are you?’ he says.
‘Guess,’ I tell him. ‘And be kind.’
‘Hmm,’ he says. ‘It’s difficult behind that mask….’
He looks me up and down, scrunches up his face in a series of exaggerated thinking expressions, then snaps his fingers and points at me.
‘Fifty seven!’ he says.
‘Wow! Dead right. Although … I’m a bit disappointed. People usually say I look younger than my age.’
‘Yeah, well,’ he says. ‘You can’t trust people.’
Then he picks up the Xbox controller, and edges his avatar towards the aliens.

willard the exception

Lolly and Richard slot around each other like two old spoons. Or two pieces of an antique jigsaw (maybe ‘Seaside View’ or ‘A Day at the Races’). Everything they do is coordinated. The way they move, for example. Even though it’s a big house they seem to continually be in each other’s way. When Lolly starts up the stairs, Richard wants to come down. When Lolly heads for the sitting room, Richard comes out. When Lolly goes into the kitchen to fetch something, Richard goes with her, so that when she turns round, she has to put her hands on his shoulders and manoeuvre past him in something that – from a safe distance – looks suspiciously like a dance. Their conversation is slotted, too. Their sentences run into each other. They finish what the other was saying. They snipe, but in such a practised and good-natured way, they’re like two elderly vaudevillians whose routine is domestic war and loving irritation. They’ve been touring this show for so long now and they know their parts back to front. It’s a job to see where one performer ends and the other begins.

They’ve got a dog, too. Willard – a Golden Retriever.

To begin with, I think it’s Willard who answers the door when I ring. It’s the way he paws it to one side, with such an open and happy expression I half-expect him to say Good Morning and How may I help? Instead, the door opens even wider and I see Lolly standing there.
‘You’re the nurse are you?’ she says. ‘Good. Maybe you can take him away. He’s driving me mad. ‘
‘Who is it Lolly? Who’s there?’
‘It’s the nurse. Come to give you a brain transplant.’
‘A brain transplant? Excellent. Ask him if he’ll give you a heart at the same time.’
‘Where do you want him?’ says Lolly, sighing and looking back at me. ‘I could give you a couple of suggestions.’
In the meantime, Richard has come halfway down the stairs.
‘I’m easy,’ I say. ‘Wherever he’s most comfortable.’
‘He wants you in the bedroom,’ says Lolly, putting a hand on the balustrade, as if she’s going to stop him coming any further by main force.
‘I’m glad somebody does.’
‘Oh dear God,’ says Lolly. She sighs. ‘He’s been a bit – you know – since the op.’

It’s one of the reasons I’ve been asked to visit, to check the wound and make sure he hasn’t got an infection. The GP has already given him some antibiotics, delivered remotely, as they often are these days. I wouldn’t be surprised if next year they started using drones. Although – to be fair – looking at myself reflected in the hallway mirror – it looks like they already are.

Lolly starts up the stairs. There’s a battle royale, Richard wanting to come down, Lolly telling him to reverse. I say I don’t mind where. Richard says he wants the sitting room. Okay I say. No says Lolly. Reverse. Lie on the bed. Willard is right behind me, smiling broadly. The four of us continue up the stairs in one well-coordinated bundle.
‘He’s been hallucinating,’ says Lolly, as Richard lies back on the bed.
‘I have not,’ he says.
‘Yes you have, darling.’
‘When?’
‘This morning.’
‘Why? What happened?’
‘There!’ says Lolly, nodding at me. ‘Even his memory’s going.’
‘No, no!’ says Richard, quite happily, adjusting the pillows behind his head and then folding his hands on his tummy. ‘I’m simply disputing your version of events.’
‘You said there was a big orange fish behind the telly.’
‘Not was, darling. Is. There IS a big orange fish behind the telly.’
‘You see,’ says Lolly. ‘D’you think it’s serious?’
‘Have a look for yourself!’ says Richard.
‘Oh for goodness sake.’
I go over to the telly.
‘I hate to say this, Lolly – but there is actually a big orange fish down there.’
‘Not you too… oh!’
We’re both looking down at the gap behind the telly. There’s a cuddly toy lying on the cables – a Finding Nemo clown fish.
‘Well who put that there?’ says Lolly.
Willard looks up at me with a broadly innocent look on his face. I’m immediately suspicious.
‘Search me’ says Richard. ‘Look – are we going to do this thing or not? Because quite frankly, I’m hungry and I want my kippers.’
‘That’s a good sign,’ I say, turning back to the bed.
‘Is it?’ sighs Lolly. ‘Is it?’

*

‘All our dogs have started with a W,’ says Lolly, as I tidy up my things. ‘First there was Winston. Then it was Willow.’
‘No, darling. No. It was Wilma after Winston. Then it was Willow.’
‘You’re quite right. Winston. Wilma. Willow. Willard.’
‘I like that!’ I say. ‘How did it all start?’
‘It was Lolly’s idea,’ says Richard.
‘They’ve all been rescues,’ says Lolly. ‘We didn’t like their names so we had to change them. Winston was easy, because his original was Branston.’
‘Like the pickle,’ says Richard.
‘Like the pickle,’ says Lolly. ‘We didn’t like the idea of calling out Branston and immediately thinking of pickle. Neither of us likes pickle. So we wanted a name that sounded like Branston, so the dog wouldn’t get confused. And Winston seemed to fit.’
‘So that was the first W?’
‘Yes. And after that it just became a bit of a thing.’
‘Wilma was originally Alma,’ says Richard. ‘But I didn’t fancy that. Shouting Alma! Alma! was like barking yourself.’
‘So we called her Wilma,’ says Lolly. ‘It was a bit tricky to begin with, because we had to bend the name into shape gradually, so the dog wouldn’t get confused.’
‘You should’ve seen her,’ says Richard. ‘Standing there going AAHHAUUUUWAUUHMMMAAA! Everyone must’ve thought she was mad.’
‘No darling. They thought I was a singer doing vocal exercises.’
I look down at Willard. He returns the gaze.
‘So – what about Willard?’
‘Ah!’ says Lolly. ‘Willard was the exception. Willard has always been Willard. Haven’t you, darling?’
And I have to admit, I’ve never seen a dog agree more.

the old boiler room

When I tell Mr Edwards the team is based at the old hospital, he straightens a little.
‘I know it well!’ he says. ‘I should do. I worked there all my life.’
‘Oh? What did you do?’
‘I used to keep an eye on the boilers, mostly. Other electrical stuff. A bit of everything, really.’

I’m kneeling on an inco pad on the floor. Mr Edward’s got his right leg propped up on a low padded stool so I can change the bandage. He shifts his leg to give me a little more room to work.
‘Better?’ he says, looking down at me with the gravitas of an old priest giving absolution.
‘Yeah, that’s very helpful. Thanks.’
‘That’s me, mate. Helpful to a tee.’

I’m sweating. I dab at my forehead with the back of my gloved hand. Maybe it’s the years of working in boiler rooms, or simply a function of his great age and reduced mobility, but Mr Edwards keeps his living room oppressively hot. The weather outside doesn’t help. The late October evening has drawn in, and a saturating fog billows along the street. To begin with, collecting the key from the keysafe and letting myself into Mr Edwards’ house felt like claiming sanctuary; five minutes later, I just want to curl up under the table, make a nest with his bags of creams and pads and medical supplies, and sleep.

‘That old hospital used to be a workhouse,’ he says.
‘Yeah – I heard that. It’s a fascinating place.’
‘That’s one word for it.’
‘Why? What word would you use?’
‘Haunted.’
‘Oh? Did you ever see anything?’
‘You wouldn’t believe me if I told you.’
‘Try me.’

He clears his throat; I sit back on my haunches to unwrap another bandage.

‘This is years ago, mind,’ he says, eventually. ‘Back in the sixties. That place was like a little village up on the hill then. It had everything – laundry, kitchens, workshops. All the wards of course, this and that. A self-contained village, with a big flint wall and a clock at the top of the old block by the road. When the Victorians built it they built it to last. Like a prison, really. Which in a way, of course, it was. If your crime was being poor. It’s been a few things in its time. Fever hospital. Lunatic asylum. Took in wounded soldiers from the Great War, and then after that they made it into a full time hospital. I started there when I come out of the army. I was only going to stay for a little bit till I found something better, but – you know how it goes.’
‘I certainly do.’

He fusses with his jacket, pulling it more tightly round himself.

‘The thing is, them Victorians built things sturdy. Especially the sewers. You could lose a coach and horses in the sewers under that old place. Honestly – it’s like a brick palace. I could walk you through most of it.’
‘I’d like that.’
‘If you did it on your own you’d never find your way out again. You wouldn’t like that so much.’
‘No. Probably not.’
‘Anyway. All the pipework went through these sewers along the ceiling. The boiler house they put in a kind of ante-chamber you had to access down a flight of brick steps. I didn’t mind it but some of the other guys got the heebie-jeebies. I suppose I was never much for that kind of thing – you know – worrying about ghosts and what have you. I had enough on my plate with the living! I’d be more scared by a knock on the door from the taxman, never mind some poor old fucker who had to rattle his chains and look miserable. None of that ever made much sense to me. Maybe I just never had the imagination.
‘The thing about that boiler room was – it was hot. And I mean proper hot. A kind of sticky heat that gets under your skin and makes your hands sweat. I’ve always liked a bit of heat, so I was in my element. I did my National Service in India. Loved it. Didn’t want to come back. Only I had to. So that was that. And you know what else used to like it in the boiler room?’
‘Ghosts?’
‘Cockroaches. They loved it down there. It was cockroach heaven. First thing in the morning, I’d open up the door, take a couple of steps down, put on the light. Straightaway they’d be this big, slippery, rushing kind of noise, like someone was emptying a tub of oyster shells over the floor. And you’d see them, all the cockroaches, scattering away back to the holes in the bricks that separated the room from the rest of the system.
‘One morning, just before Christmas, I had to go down the boiler room again. I opened the door as usual, took two steps down, and put on the light. This time, instead of the usual rushing sound, there was nothing, only a horrible kind of quiet, the kind you get before it snows. And standing in the middle of the room was this little boy.’
‘A boy?’
‘A tiny little thing, in a workhouse suit and cap. He was just standing there, staring up at me, with eyes half the size of his face. And before I could say anything he sort of collapsed – melted away – and there was that rushing noise again, and thousands of cockroaches running all over the floor, back into the bricks.’
‘That’s horrible!’
‘I was pretty shaken up.’
‘I bet! What did you do?’
‘I didn’t tell anyone. I said I felt ill and had to go home. They thought I was swinging the lead because it was near Christmas, but I daren’t tell ‘em the truth. I was dreading going back ‘cos I’d lost my nerve a bit. But things worked out. They’d decided to relocate the boiler ‘cos of ventilation issues. I only had to go down there a couple times more, but I never saw the kid again.’
‘Do you think he was warning you it wasn’t safe?’
‘Maybe,’ says Mr Edwards. ‘I don’t know. But like I said, it’s easy to get lost down there.’

kuba uber

The nurse Kuba was allocated to is off sick, so he’s slumming it with me. Kuba is a second year nursing student, on a placement with our team for a few weeks, this being his second day. He’s a tall, heavy guy in his twenties, placing his words as slowly and carefully as his feet.

We’ve had radically different mornings. I’ve been stuck in the office, coordinating pretty much single-handedly all morning till two, and it’s been horribly busy. I’ve done my best to look cool and in control, but mostly I’ve felt like Wile E Coyote running off the canyon edge, pedaling desperately, looking at the camera with a crooked smile as gravity takes me down.

Meanwhile, Kuba has been working through a bunch of dull, online training. So whilst I feel positively light-headed as I step outside the hospital door into the car park, the world wide and wonderful around me, and only two patients to see before I go home, Kuba is as depressed as a bear who’s been dragged out of his cave for no particular reason.
‘What a world!’
‘Yes,’ he says. ‘Is very nice.’

My car is small. I move things around to make room, but still, a bear’s a bear. He sits in the passenger seat, smooshed up against the ceiling, his paws hugging the bag on his lap, staring ahead.

I ring the first patient, an elderly woman called June who lives pretty close by. She sounds remarkably bright on the phone.
‘I look forward to seeing you both!’ she says.
I put the phone back in my pocket, both of us having to lean left and right to make room.
‘She doesn’t sound ninety-five!’ I say.
He shrugs.
‘If I didn’t know I’d say she was seventy,’ I say.
‘Seventy is old,’ he says. ‘What is wrong with this lady?’
I go through what I remember reading from the discharge summary.
‘So – exactly the kind of thing would be wrong with old lady,’ he says.
‘I suppose.’
‘And what is purpose of visit?’
‘Anyone who gets referred to us has to have a basic set of obs, including pressure area check and an up to date weight.’
‘Why?’
It’s my turn to shrug.
‘So we reassured everything’s okay.’
‘Let us go then,’ he says. And yawns, just like a bear.

*

June lives in the middle of a row of terraced houses off the main drag. There’s a water company van outside, and I wonder if something’s happened.
‘No, that’s for Margaret next door. She’s having trouble with her pipes. Come in, ducks.’
The house seems to tip towards the road as Kuba follows me inside.
‘Ooh!’ says June. ‘You’re big.’
‘I’m about average,’ I say.
‘Not you. Him.’
Kuba shrugs. Yawns behind his mask.
‘Where do you want me?’ says June.
‘Kuba? Why don’t you do the observations?’
I hand him the equipment from my bag, along with a disinfectant wipe.
‘Please give me arm,’ he says, waggling his claws towards June.
‘Be gentle,’ she says.
‘Relax, please,’ he says.

Next to the sofa is a large cage filled with tiny mirrors, dangling bells and a crazy looking budgie with a big red stripe running from its beak over the top of its head and down its back.
‘That’s Bowie,’ says June. ‘And he’s not a budgie he’s a parakeet. And he doesn’t talk.’
‘Do they normally?’
‘Quiet please,’ says Kuba.
Bowie assaults a mirror.

Behind Kuba on the wall are a selection of family photos in frames. Some are really old – the middle one around which all the others radiate is an ancient, black and white profile shot of a severe looking woman in a button-up crinoline dress. Kuba takes the cuff off June’s arm so it’s safe to ask her who the woman is.
‘That’s my great-great grandmother, Clothilde,’ she says. ‘She was French, you know.’
‘Was she?’
‘Yes, she was. Can you see a likeness?’
I look from one to the other.
‘I think I can,’ I say.
‘What is it?’
‘The nose.’
June laughs.
‘Le conk! I know! Shame, in’t it?’

*

‘Who is next patient?’ says Kuba as we head back to the car.
‘It’s a guy who needs the dressing on his arm changing. I think he fell over a couple of days ago, the ambulance came out, and they referred on to us. Once we’ve changed the bandage we can discharge to the district nurses. If he needs it.’
I glance at him and smile.
‘And then I can drop you home!’
‘Thank you very much.’
‘Got any plans for the rest of your day?’
‘I have to go to supermarket,’ he says. ‘Then some studying.’
‘What will you do when you finish your degree? Are you looking to specialise?’
‘Yes. I want to work in trauma,’ he says. ‘Something interesting.’

*

Half an hour later we’re standing outside the main door to a block of flats. A neighbourhood tabby cat comes trotting over when it sees us park; it sits next to me on the ground by the door whilst Kuba tries to figure out which keysafe belongs to our patient.
‘Hey mister!’ I say, bending down to fuss the cat between the ears. Normally a cat will pretty much levitate when you do that, but this cat means business. It stares at Kuba and narrows its eyes.
‘Which box is it?’ I say to the cat. ‘Which one’s Harold’s box?’
‘Is cat,’ says Kuba. ‘He cannot tell you.’ He sighs, and flips the cover off another box and starts pummelling the numbers.
‘Worth a try, though. Eh?’
I lean into the cat a bit more and whisper: Go on! Point! Which one’s Harold’s…?
Kuba flips the second to last box open and pulls out the key.
‘Got it!’ he says.
The moment he opens the door the cat rushes in, only pausing for a second to give us a particularly harsh look from the first landing, then turns and hurries on.
‘He will never get out,’ says Kuba. ‘That is end of cat.’
‘I dunno. I get the impression he pretty much owns the place,’ I say.
We go up the stairs, a great deal more heavily and slowly than the cat.

Turns out Harold’s door is on a chain.
‘Who is it?’ he says from inside.
‘It’s Jim, the nursing assistant from the hospital. We phoned earlier…’
There’s the sound of someone cursing, breathing hard. A woman’s voice, thin, worried. A creaking noise, presumably the walking frame – then after a while Harold appears, pressing his face to the gap like Jack Nicholson in The Shining.
‘What do you want?’ he says.
‘We’ve come to change the dressing on your arm, Harold. Do you remember?’
‘Can I see some identification?’
‘Of course!
I extend my badge on its sprung line and press it to the gap.
‘Hmm,’ he says. ‘Hah. And that’s supposed to be you, is it?’
‘Yep. I was younger then. Optimistic.’
‘Well…Alright then.’
He rattles back the chain, opens the door, and stands there holding onto it.
‘After you!’ I say. (If he falls I want to be able to catch him).
‘No. You go on,’ he says, waving me past. ‘Just go. Dorothy’s there.’
We let ourselves into the living room, where Dorothy is sitting in a high-backed chair, her legs barely touching the floor. She’s a broad, approximate figure, like someone made a sculpture by stuffing an old kimono with scatter cushions. The most extraordinary thing about her is her hair, which sticks straight up, like she fell into the chair down a chute three floors up.
‘Hello Dorothy!’ I say. ‘I’m Jim. This is Kuba. I’m a nursing assistant, Kuba is a nursing student. We’ve just popped in to take a look at Harold’s arm. Sorry to disturb you.’
She tuts, and fiddles with a handkerchief.
‘If you’re nurses,’ says Harold, wheezing into the room. ‘How come you haven’t got a box?’
‘I carry my dressings in a bag,’ I tell him. ‘I don’t like those boxes. They’re too cumbersome.’
‘Cumbersome?’ says Kuba.
‘Yeah. You know. Boxy.’
‘I don’t know about this…’ says Harold, frowning so hard his eyes disappear. ‘Who sent you?’
‘The paramedics who came when you hurt your arm. The day before yesterday. D’you remember? They wanted us to come in and check everything was alright, and then maybe get the District Nurses to see you in a couple of days.’
‘I don’t know,’ says Harold. ‘I think I’ll leave it, if it’s all the same to you.’
‘It’s your choice,’ I tell him. ‘But would you mind if I asked you a couple of questions about your arm before we go?’
‘What like? What questions?’ says Harold.
‘Is painful?’ says Kuba. ‘Is scratchy?’
‘What’d he say?’
‘Is your arm troubling you at all?’
‘No. Not a bit!’
‘Do you feel unwell?’
‘I feel fine, thank you.’
‘I can’t see any strikethrough on the dressing…’
‘Strikethrough?’
‘Sometimes the wound gets infected and a bit oozy. It starts to seep through the bandage. But that all looks pretty clean.’
‘I’ll wait for the District Nurses, if you don’t mind,’ he says.
‘Okay. That’s fine. I’ll make a note on your record. Sorry to have disturbed you.’
‘Right you are.’
I pick up all my bags again and we both leave.

Outside the main door again, Kuba sighs and looks around.
‘I was right about cat,’ he says. ‘Now. Please take me home.’