malcolm the robot vs. tina dreadful

Tina’s surname is Redmond but everyone calls her Tina Dreadful.

Nothing prepares you for her. Nothing. Not meditation. Not medication. Not prayer.

You’d have to say Tina is following her vocation. She’s raised nastiness to the level of art. Made rudeness a competitive sport. Transformed vileness and good ol’ fashioned meanness into a spiritual quest. She’s racist, sexist, casually abusive. She’s uncooperative, obstructive, distracting. Now and again she’s content, in the way that torturers turn off the loud television sometimes, to soften you up for the next onslaught. Mostly, though, she’s just a bully.

I defy anyone to visit Tina and keep their cool.

The Dalai Lama would stomp across the road and kick a trash can.
Mother Theresa would storm out of the front door, tear off her headdress, fling her sandals up at the window. (And then swear at you for tutting).
The Pope would hurry outside, kiss his cross, light a fag, jump in his Pope Mobile, and do a doughnut in the street in his hurry to get away.

Tina is on a slowly repeating cycle, a sine wave of sickness and degradation. On the downward phase she self-neglects to the point of ill health, gets admitted to hospital (when she’s so far gone she can’t protest); the deep-clean team goes in to steam-blast the floor, replace the bed, buy in new sheets and towels and so on; Tina gets discharged back with a package of care, and the whole cycle starts again. Over the years, Tina has left many tearful health care professionals in her wake. She’s had umpteen multi-disciplinary meetings between the council, social services, neighbourhood representatives, psychiatrists and police, but no amount of special delivery letters, no amount of signed contracts or verbal consents, have done anything to change her situation or her character. She does have mental capacity. None of this has been found to be an expression of mental illness. It’s just plain cussedness, and no-one seems able to do anything about it.

I met her daughters once. They were the loveliest, most caring women you could imagine. But they’ve lived so long in the foothills of this dark and forbidding personality they can only protect themselves as best they can, apologise, try to make amends, and wait for the next rockfall.

However, I have to say, now and for the record: Malcolm can handle Tina.
And I’ve finally figured out how he does it.

Malcolm is a robot.

Here’s what I think happened.

I think a scientist – mad or otherwise – sat in on one of the multi-disciplinary meetings. I think this scientist patiently listened to everyone moaning on about the latest awfulness, and then when things fell quiet, calmly got up, went to the door, opened it, and invited Malcolm in.

Malcolm is perfect. He’s average height, medium build. He has a hairless, wipe-clean head. He has cool, evaluating eyes and realistic hands. He speaks with great modulation, in phrases designed to advance understanding and minimise flare. He moves with economy – but there’s power there, too, on a graduated scale from 1: puncturing the film on a microwave meal or 2: kicking through a wall. His demeanour is gyroscopically monitored, one hundred and eighty degrees of equanimity and poise. And his battery is good for eight hours.

You might think it’s a bit extravagant to use a robot such as Malcolm in this banal social situation. But maybe this is a field trial. Maybe this is part of the stress-testing you’d want to put such a unit through before you send them off to recolonise Mars or something.

The fact is, he’s amazing.

And the reason I think he’s a robot? Two things.

1: When the other carers see that they’re down to visit Tina they wail and plead and do everything they can short of throwing themselves out of the window to escape having to go. Malcolm just smiles.

2: Reading his notes afterwards. He writes coolly, neutrally, with great measure. You get a sense behind his words of the vile language Tina is using, the awful tenor of the situation, but nowhere does Malcolm rise to it. He describes himself moving through the scene, relaying the facts with a detachment that borders on nervelessness.

But the biggest giveaway?
He talks about himself in the third person.

For example: The Carer suggested that Tina roll to the left a little so he might change the inco sheet. Tina declined to do this, saying that she did not want to. The carer pointed out the negative effect lying on urine soaked sheets would have on the integrity of Tina’s skin. Still, Tina declined to cooperate. The carer asked Tina whether she would like something prepared for lunch. Tina declined, saying there was nothing in the fridge. The carer suggested he look in the fridge. Tina said that he could if he liked, it was a free country. The carer looked in the fridge and discovered a microwave meal – sausage hot pot and dumplings. The carer presented this to Tina. Tina said she was sick of sausage hot pot and dumplings and she would rather starve. She then went on to describe issues she was having with her mobile phone, a Sim card problem the Carer was not able to resolve at this time. Tina made comment about this in a generally abusive manner. Tina then requested the sausage hot pot and dumplings be heated anyway, which the Carer proceeded to do. The carer made tea, which Tina declined in favour of pineapple juice. Then Tina said the tea was not sweet enough, and she required apple juice not pineapple juice, and not in that beaker. Then she spilled the tea and had to be cleaned up. The Carer then presented the sausage hot pot and dumplings in a bowl. Tina used many swear words when the Carer placed the bowl beside the bed, saying that ‘it was no good there, was it’ even though she could easily reach the bowl. The Carer took action to remedy the situation, and with nothing further to be accomplished, left the scene, all being well at that time.

We need more Malcolms.

in the cage

Imelda’s flat is so small and cluttered it’s like trying to install a commode in a hamster’s sleeping compartment.
‘By the bed’s fine, love,’ she says. ‘I can shuffle m’self straight onto it.’

Shuffling seems to be Imelda’s primary means of getting about these days. Her legs are terribly raw and swollen, and with decreased mobility has come significant weight gain. You might call it the snowball effect – if the snowball had given up rolling, was covered in a rash, and its internal organs were squealing under the strain.
I ask her if she’s got family nearby.
‘Five kids,’ she says. ‘They’ve all done well. Went to college and everything. America. You name it, they’ve done it. And I brought them up all on my own.’
‘That must’ve been hard.’
‘It was hard. My husband died young and there I was, five kids, looking around and wondering what the hell I was going to do about it.’
‘What happened to your husband?’
‘He was killed at work. A big door fell on him.’
‘How awful. So what did you do?’
‘I didn’t have a clue. It wasn’t like I was good for anything much. I wasn’t trained like he was. I didn’t have certificates. Shelling out kids was mostly what I’d done. But once he’d died I had to find a way to put food on the table and shoes on their feet. So I went dancing. And it turns out there was good money in it.’

When I ask her what kind of dancing, I think she says ballroom.

‘You must’ve been really good.’
‘I was good. You wouldn’t think to look at me now, but loads of people came to watch.’
‘That’s amazing!’
‘Yeah. I had a wonderful time. And I made so much money through tips the kids did alright. And now look at them. America and everything.’
‘Tips?’
‘They’d stuff the notes in your costume.’
‘I had no idea there was so much money to be made ballroom dancing.’
‘Ballroom dancing? No! Pole dancing.’
‘Oh!’
‘Can you imagine me swanning around in a chintzy skirt? Don’t answer that.’
‘So you were a pole dancer?’
‘And I was good. I took the kids with me up to London and I did very well. There was a guy there, one of the big club managers, and he said to me Imelda? I’m going to make you a lot of money – but don’t worry! Not like you think! You’ll be quite safe.
‘And were you?’
‘I was. He put me in a cage.’

back to baseline

‘Do you know who we are? Has anyone told you what we do?’

I say it a lot. Almost as many times as I say ‘Do you have a yellow folder?’

Sometimes I feel like an actor in a long-running play, overly conscious of his hands in the middle of a monologue on a wet Wednesday matinee in February.

But that’s the trick, I suppose. Finding truth in the same old lines, even though you’ve said them so many times they’ve picked up a dodgy shine.

‘We’re an NHS community health team. We’ve got lots of people working for us – nurses, nursing assistants (that’s me), physiotherapists, occupational therapists… you name it!…We’ve got a small bank of emergency carers… we’ve even got a pharmacist!’

I like putting that one in. It makes us sound like a friendly high street, all the usual shops.

‘We work on a pretty tight schedule. Just three days. We get referrals from the GP, who might be worried someone needs a little extra support. We get referrals from the ambulance, who might have gone round to someone who fell, for example, and they want us to follow up to make sure everything’s okay. Or a referral from the hospital, because someone’s being discharged and needs help. That kind of thing. So we pitch in, see what’s what, and either refer the patient on to a more specialist health team like the Respiratory nurses, the Heart failure team, the District Nurses and so on. Basically we’re here to keep people safe at home and help them stay out of hospital if possible.’

Invariably the patient will interrupt on the second sentence of the spiel, though.
‘Three days! Is that all?’
And if they do, I’ll say something like: ‘Well – yes – we are what they call an acute service. We’re very short term and we do try to move people on as soon as we can. But the bottom line is, we won’t leave anyone in the lurch. We’ll keep patients on for as long as it takes for the other team to pick-up.’

Mostly that works. Sometimes they fixate on the three-day thing, and it takes a bit more reassurance. More often than not, though, they’re just relieved to have someone – anyone – coming through the door. Because a great many of the patients we see are struggling. They may have suffered a recent exacerbation of their health problems, an accident or an illness. Maybe they’ve suffered a change in their social circumstance, the death of the partner who was their main carer, or some other family breakdown. But although the specifics of their situation change, the basics stay the same: they can’t cope, and they need help to get back to coping, whatever that might look like.

There’s a phrase you see used a lot in the team – Back to baseline – a simple expression of the outcome we’re looking for. Back to baseline means getting the patient back to where they were before they needed all these interventions.

A simple plan. And like all simple plans it hides a world of negotiation, and difficult decisions, and compromise.

Back to Baseline.

‘Any questions?’

what a ride

The best way to see Helmstone is by seagull – if you’re a pixie, don’t have a drone, have no interest in drones, or actually, you DO know someone with a drone but you wouldn’t feel happy throwing your leg over anything with rotors – although the seagull doesn’t seem much better, having a huge beak and a pretty terrifying kind of appetite. But then, I’ve no idea about seaside pixies. They may well have a good relationship with seagulls. Unlike town pixies, who have a thing for pigeons but a terrible allergy to crows. But I digress. The point is, you’re an incredibly cute little authorial device, you’re able and sufficiently motivated to ride a seagull, and you’re all set to give us a tour of this wonderful seaside town that, from the point of anonymity, but entirely unconvincingly, I’ll be calling Helmstone.

Okay?

Good.

So.

Also – I should say – because I want to start the tour from out at sea, for artistic reasons, I’ll be assuming you’re friends with a fisherman, who maybe rescued you from the crappy canoe you made out of coke cans, and you owe him big time for that, and he’s pretty kind anyway, even though economically he’s not doing so great, and there are official letters waiting at home he’s VERY reluctant to open. But whatever – he hooks you from the water a couple of miles off Helmstone, and after some fantastically witty dialogue that I haven’t got time to go into now, he agrees to let you ride the tame seagull who often hangs around his boat,  and who’s looking a little jealously at you, so you can take a tour of the town that will benefit the readers and give them some local colour. And no doubt the fisherman’s hoping that maybe when you’re done you’ll come back and do some interviews and talk shows with him, and make him enough money to carry on doing the thing he loves best, which seems to be sinking empty lobster pots into the English Channel, and hauling them up still empty twelve hours later.

The fisherman – let’s call him Steve, although personally I’m not at all convinced by that, but I don’t want to waste any more time thinking up a better name, because ‘Steve’ doesn’t feature at all in the book except for this dreadful prologue, which I hope you’ve skipped, but there we are – Steve helps you onto the bird’s back, which is waiting at the front of Steve’s crappy little smack, flicking its wings nervously, wondering what the old guy’s planning now, and maybe it’s time to find another boat to hang around. Steve fits the seagull with a hilariously inept canvas saddle and reins made out of dental floss – something the seagull REALLY doesn’t want in its beak, but Steve insists, because it’ll give you some measure of control. And he gives you a cute little flying hat, and a snug little fur jacket he made out of the pelt of a rat, for God’s sake, which you hate putting on, but you don’t want to upset the guy, because he’s doing his best, and anyway, this book will never get started if you don’t agree to wear the horrible fucking rat jacket.
And he says farewell my brave little aeronaut, quite patronisingly, and throws you into the air. And for a second you’re terrified the seagull is planning to flip you over its head and swallow you whole, either because it’s hungry, or because it’s a seagull, and in the rat jacket you look exactly like a rat, which seagulls have long-standing issues with. But let’s just say the seagull comes to terms with it, finds its wings, and actually starts to enjoy having a flying buddy. And the two of you soar away into the sky, circling once overhead to wave at Steve down below, who’s inadvisably standing up his smack, waving his cap, which he loses overboard, and then follows with a splash. And you can’t help laughing, despite everything the poor guy’s done for you, because you’re a cheap little pixie who really doesn’t deserve anything good.

But there you go.

So.

Fly low over the waves, lightly, through the gobs and spits of foam, and watch as the city of Helmstone slides up into view, acquiring definition as you skim towards it, a strip of beach, red brick arches, iron walkways, hotels, conference centres, traffic on the coast road. Rise up over the pier. Rise up along the mackerel lines of the old fuckers at the end, up over the theatre and the hurling seats on the end of crane arms fairground rides, squabbling with the other gulls that scavenge the boarded length of it, high over the heads of the winter crowds there, and follow the boards to the pebble margined land. Snick over the pointy top of the old iron clock; over the beach and the giant blue Slush puppy dog and the crazy golf, the chip stands, the EFL kids throwing pebbles into the sea; bank down and round, faster now, with more purpose, to skim the traffic stalled by the aquarium, up towards the Victorian one way system; go graciously by the hand of a green and bilious Queen, her celebratory gardens, the council workers prodding in bulbs for the spring; come in low along the cycle paths, the bus lanes, the pot-holed roads; flash along past the tourist tick lists, the anonymous business frontages, past the fake Tudor pub, the computer-designed flats, the Georgian terraces and wrought-iron balconies, leave in your wake the traffic stalled by the skate park, the converted municipal buildings, mews apartments and student halls; pull up over the bendy-buses queuing at the lights, blocking the junction; blast away up the hill towards the edge of the great half cup that forms this seaside town, easing off on the seagull’s reins as you reach the top, banking into the  entrance of the old workhouse they made into a hospital; fly up the drive; glide to a stop on the window ledge of the first floor; catch your breath – and when you’re ready, let the seagull tap once on the window with its beak.

And wait.

work it, baby

With his thick black hair shaved at the sides and gelled back in a riotous, rockabilly quiff, white framed sunglasses and perfect designer stubble on perfect designer cheekbones, Ethan the nurse makes every visit a fashion shoot. I can see him waiting for me further up the street. He’s lounging back against a lamppost, one white trainer kicked back, the furry grey hood of his parka arrayed like a luxurious ruff around his neck. He’s snapping gum, staring at the cars going by. He looks fabulous.
‘Oh there you are !’ he says, pushing himself upright, flashing me a look over the rim of his sunglasses. ‘I wondered where you were. I was clean-shaven when I got ‘ere.’

We’ve come to see Martin, a difficult patient with a history of drug and alcohol abuse, a few incidents of aggression. I’ve met Martin before – admittedly a while ago. He’s young, but only on paper. When I met him he’d just been discharged from hospital following a fall down a dozen steps and a long lie at the bottom. The fact he survived at all was a miracle. But miracles are fleeting, and there’s always something waiting the other side of them. In Martin’s case it’s a list of medical acronyms that reads like a roll-call for the damned. What’s worse is his recent history of non-compliance, missed appointments, saying one thing and doing the opposite. He was referred to us by the hospital again, this time to dress an abscess in his thigh, the latest wound from his attempts to find anything resembling a patent vein. We’ve been formally tasked to get him to sign an official waiver if he declines help again, so long as we feel he has capacity.
‘Feeling lucky?’ I say to Ethan.
‘Darling – I was born lucky,’ he says. ‘The rest is just exercise and a great skincare routine.’

Martin is staying in supported housing – in this case, a pleasant-looking semi in a tree-lined street, a tall privet hedge screening it off from passers-by. A mosaic path runs from a gap in the hedge through a functional, stone chipped garden to the front door. There’s a brushed steel intercom by the door with a line of illegible, rain-smeared names by the buttons.
‘Shall we ring it?’ says Ethan.
‘Let’s ring it.’
‘You ring it.’
‘No you ring it.’
‘Okay I’ll ring it.’
Ethan rings it.
Rings again.
Eventually a woman answers in a drawly voice.
‘Who is it?’ she says.
‘Oh hi there!’ says Ethan, leaning closer to the intercom and giving me a cartoon-panicky look at the same time. ‘It’s Ethan and Jim, nurses from the rapid response team? We’ve come to see Martin?’
‘He can’t see you. He’s ill,’ she says.
‘Ah. Well. That’s probably a good reason for us to come in, then. I mean – you know – being nurses and everything…’
‘I told you. He’s ill. Come back tomorrow.’
‘Erm… we kind of need to see him face to face so he can tell us himself,’ says Ethan. ‘Otherwise we’ll get in trouble. Would that be alright?’
‘No,’ she says. ‘Come back tomorrow.’
The intercom goes dead.

Whilst we’re standing there wondering what to do next, a man and a dog appear through the hedge. They both look extraordinary – the man because he has a heavily tattooed face and more piercings than the cenobites in Hellraiser; the dog because it has three legs and a lop-sided, piratical expression.
‘Who’ya’fter?’ he says.
‘Oh, hi there!’ says Ethan, shrugging and tipping his head coquettishly on one side. ‘We were just wondering if we could come in and see Martin?’
‘Martin?’ says the man, frowning. ‘No. You can’t. He’s ill.’
‘Yeah. I know. We’re nurses.’
The man fishes a key out of his pocket (although I wouldn’t have been surprised if he pulled it out of his ear).
‘No,’ he says. ‘Come back tomorrow.’
And he lets himself in.
Only the dog looks back.
The door slams shut.
‘Fine! Suit yourself!’ says Ethan, shouldering his bag. ‘Waste my time why don’t you!’
He puts his sunglasses back on, and we leave. The sun comes out. Ethan walks down the path with an exaggerated throw of his hips.
‘Work it, baby!’ he says.

me, maud & peter o’toole

Maud is watching ‘Lawrence of Arabia’ on a plasma TV screen so enormous you’d need a camel to get from one side to the other. She’s sitting in a padded wheelchair, her bad right leg straight out on a leg support. It’s a nice contrast, seeing Maud in her wheelchair like that, Peter O’Toole on his camel. I picture her tying her leg to the hump.
‘Have you ever ridden one of those?’ I ask her.
‘No. But I went on the dodgems once.’

Maud’s daughter Isabel is supposed to be meeting me here. She’s already rung to apologise and say she’ll be late, though. Apparently the taxi driver sat outside her house and didn’t bother letting her know he was there.
Maud shakes her head.
‘That’s Isabel for you,’ she says.
We’ve done all the medical stuff so there’s nothing to do but wait. Isabel has some questions and concerns, so I need to hang on for a while.
‘I hope she won’t be long,’ I say.
‘She’ll be twenty minutes,’ says Maud. ‘You can set your watch by it.’
We watch as Peter O’Toole and his guide draw water from a well in the middle of a vast expanse of desert. Suddenly they see a shimmering black shape in the distance. A mirage? What is it? The shape gets bigger. A figure on a camel, riding straight at them. The Arab guide fetches out a rifle and takes aim. Peter O’Toole tries to stop him but it’s too late. The approaching figure fires first; the guide drops to the sand, dead. Finally the figure arrives. It’s Omar Sharif.
‘Now there’s a good looking man,’ says Maud, pushing herself more upright in the wheelchair. ‘He can shoot me any day.’
‘I’ve got a story about Omar Sharif,’ I say.
‘Oh yes?’
‘My brother in law is Lebanese. Or was. He’s dead now, unfortunately.’
It suddenly strikes me it’s an odd thing to say. Do you stop being Lebanese just because you died? Maybe you do. Maybe that’s death. You stop being anything.
‘What did he die of?’
‘Cancer.’
‘Yes,’ says Maud, flatly, as if she expected it all along.
‘Anyway, he used to work in Maroush, a famous Lebanese restaurant on the Edgware Road.’
‘I’ve heard of it. I think.’
‘It’s pretty swanky. Saad was the Head Waiter. One day Omar Sharif came in, surrounded by all these glamorous people. Saad went to take their order and settle them in, and Omar looked up at him and said: Would you like my autograph? And Saad said: No. Would you like mine?
‘I liked him in Doctor Zhivago,’ says Maud. ‘He was lovely in that.’
‘I haven’t seen that one.’
‘No? You should.’
Me, Maud and Peter O’Toole watch Omar Sharif ride away on his camel.
The door bursts open. It’s Isabel.
‘So sorry about that!’ she says. ‘Stupid driver.’

feeling the heat

Anna, the coordinator for the early shift, waves me over.

‘Jim? I’ve got a P2 for you, darlink. Nothing massively urgent but I think if you could go there this morning that would be wonderful. I’ve sent it through to you. See what you make of it. Let me know if you need anything else. Okay, darlink? Perfect. Okay? See you later.’

I’m about to ask her something but the phone starts ringing again. She pulls a face, holds up a finger, answers the phone – and immediately gets drawn into something complex. It’s early in the shift and she’s already quite red in the face. Some of that’s the office. The boilers here seem to have two settings: OFF for the summer, ON for the winter – ON being approximately The Surface Temperature of the Sun. It’s ironic that there are disposable cardboard thermometers pinned up around the place, the kind that we give out to our elderly and at risk patients. All of them are so far in the RED zone the caption advises calling 999. Nothing ever changes. We stew when we come back to the office to catch up on admin and stay out as long as we can.

I touch Anna on the shoulder, nod and smile as if to say don’t worry, I’ve got everything I need, and loosening my collar, head for the door.

*

A P2 faller is a patient who needs to be seen reasonably urgently but a little delay is probably fine. The ambulance  made the referral. They had attended Mrs Davenport that morning for a non-injury fall, and identified a few things they thought we could help with.

She doesn’t answer the phone when I call, which is a little concerning, given the history. There’s a keysafe number on the referral. I decide to go over there on spec, just in case she’s on the floor again.

*

‘Hello? Mrs Davenport? It’s Jim, from the Rapid Response Team.’
Nothing.
I’m standing in a long, bare-boarded hallway that stretches ahead to a steep staircase, and past that, into a kitchen with the faintest spill of light.
‘Helloooo? Mrs Davenport? It’s Jim. From the hospital.’
Nothing.
I decide to go into the kitchen first.

The light is coming from a table lamp, set by a rubbed but comfy-looking armchair. There’s a bottle on the floor by one of the claw-foot legs, and a dirty tumbler on a table to the side. I’d guess from the look of the kitchen it’s the place Mrs Davenport spends most time. There’s a Roberts radio next to the tumbler, its aerial so bent she either fell on it or took a bite when the news was bad. Either way, it’s resolutely off.
‘Mrs Davenport? Hellooooo?’
The place has a hunkered-down feel. Stuff piled in the sink. Curtains drawn.
There’s a door at the back. I knock and open it. A toilet and washbasin, both the worse for wear.
‘Hellooo?’
I retrace my steps and begin opening the doors along the hallway. The first is the old sitting room, completely dark, nothing to suggest that anyone’s been in more recently than 1962. Opening the next door makes me jump, because there are coats hanging from a hook and they swing out a little. The next door is Mrs Davenport’s bedroom.
‘Hello?’
She’s lying in bed, completely covered by a quilt. All I can see – apart from the lump in the quilt – is a spread of lank grey hair on the pillow.
‘Mrs Davenport? Hello. Sorry to bother you. It’s Jim, from the Rapid Response Team.’
‘What?’
A clawed hand pushes the quilt from her face and she glares at me.
‘What do you want?’ she says. It’s like I’ve disturbed a wild creature, an owl or something.
‘I’m so sorry to wake you like this,’ I say. ‘I was asked to come and see you by the ambulance.’
‘The who?’
‘The paramedics. They said they picked you up when you fell this morning.’
She blinks a few times.
‘I did not fall,’ she says. ‘I slipped.’
‘But you didn’t hurt yourself, so that’s a blessing.’
She blinks again. It’s like being photographed.
‘Why would I have hurt myself? I went to sit on the bed. I slipped gently to the floor. That’s it.’
‘But then you couldn’t get up.’
‘So I pushed my button. As I’ve been told to do. The paramedics came. They helped me up.’
She stares at me, a little more awake now.
Who did you say you were?’
I tell her, explaining as simply as I can what the Rapid Response Team is, and how we can help.
‘But I don’t want any help.’
‘That’s fine. We’ve only come round because the paramedics said so.’
‘We?’
‘Well – me. But there are other people on the team, as I say.’
‘I was asleep!’
‘And I’m so sorry to have disturbed you.’
‘I don’t understand why you’re here.’
I take a different tack.
‘Are you feeling unwell?’
‘No! Why would I?’
‘Are you in pain? Is there anything troubling you at the moment?’
She stares at me for a very long time, then hooks the quilt back even further so she can get a better look.
‘Yes,’ she says, eventually.