sketches

doolally

~ jim clayton ~ Leave a comment

There’s no sign of a keysafe at the front of the building. Some of them have a ruling about these things. Even though the majority of the residents are elderly and vulnerable, they think the little black boxes on the walls are unsightly. In which case I figure it’ll be round the back. It’s the kind of detail that would be really helpful to have on the notes, but who knows? Maybe I missed it or something? I pick up all my bags and walk back out to the road, along the front of the block, down a service road, and up to the rear access doors. I can immediately see the keysafe, clamped to the wall above the recycling bins, like some kind of robotic mussel at low tide. Worryingly, alongside it I can also see a keypad. As if to illustrate what it’s for, a guy walks up, taps in a code, and then smiles at me as the automatic door swings open.
‘Wanna come up?’ he says, reassured I’m genuine by my uniform and bags.
‘That’s okay. I’d better use the keysafe to get the keys for the flat,’ I tell him. ‘Thanks anyway.’
The door closes after him.

Of course – the number doesn’t work on the keysafe and neither does it work on the keypad.
I take out my phone and ring the patient.
‘Hello? Mrs Craig? It’s Jim, from the hospital.’
‘Yes?’
‘Well – I don’t know – I’m outside the back door, and the keysafe number doesn’t seem to work. I wonder if I’m at the right door…?’
‘Is it the first one you came to from the road?’
‘Yes.’
‘Then it should work.’
‘There’s a keypad here, too.’
‘Yes.’
‘I don’t have the code.’
‘Why not?’
‘I don’t know.’
‘7439E.’
‘Okay. Great. Thanks.’
‘Come up to the third floor. I’ll open the door to you.’

I ring off. Punch the numbers into the keypad. The automatic door swings open. I go inside. Take the lift to the third floor, then stand in the lobby, looking round. Mrs Craig lives at fifty-two; the highest number here is twenty something. There must be another rear entrance to this place. So I take my bags, head back down in the lift, exit the block and walk further along.

There’s a guy in pristine white overalls slowly painting the first of a series of pristine white garage doors. I wonder if at the end of the line he stands up straight and paints himself. I nod as I pass; he stops to stare at me, then carries on when I’m far enough ahead not to worry about.

I was right. There is a second entrance, deeper set than the first and camouflaged by some planter shrubs. I try the number on the keypad. The door swings open. I take the lift to the third floor. Mrs Craig is standing waiting at the open door, clinging on to a kitchen trolley and trembling.
‘What took you so long?’ she says.
‘I’m really sorry. I went to the wrong door.’
‘Patently!’ she says, then tuts, turns, walks unsteadily back into her flat, her coffee cup rattling on its saucer, more with rage than infirmity it seems to me. I follow on behind.
The flat is immaculate. It’s like walking into a computer reconstruction.
‘I’d better take my shoes off,’ I say to her.
‘Yes,’ she says.
The living room is forensically clean, every item of furniture, book and photo, every picture, piece of wax fruit and ceramic chicken meticulously measured and set each to another like random items on a grid. I’m the dirtiest thing this place has ever seen, and it gives Mrs Craig obvious pain to watch me drop my bags and sit down on the Ercol sofa.
‘I didn’t get all the access details,’ I tell her.
‘Why not? Wasn’t it in the notes?’
‘Not that I saw.’
‘Vihaan came straight here.’
‘Did he?’
‘Yes. And Barbara did. And Anna.’
‘Oh.’
‘Do they have access to the same notes?’
‘They do.’
‘Oh.’
‘Maybe it was in some obscure place.’
‘Not so obscure that three other clinicians came straight here without any bother.’
‘No.’
‘Perhaps you’d better read the notes more carefully next time.’
‘Probably a good idea.’
I unpack the first of my bags.
‘I saw the numbers weren’t running in the right direction,’ I tell her, trying to strike a breezy conversational air, ‘…but I thought there might be a corridor connecting the floors.’
‘Well there isn’t.’
‘No.’
‘We don’t associate with the low numbers.’
‘The riff raff.’
‘I’m joking, you understand?’
‘Yes. Me, too, Mrs Craig.’
She smiles in a thin and approximate way.
‘Anyway,’ she says. ‘That’s all in the past now. The thing is – are you here for my fingers?’ She waggles a bandaged hand in my direction.
‘Yes,’ I say. ‘Fingers.’
‘Good,’ she says. ‘Because they’re sending me absolutely doolally.’

a big ol’ splash

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Vince has been having trouble with his catheter. It’s all been pretty traumatic for him these past few days, from the discomfort of going into urinary retention in the first place and the trauma of the catheterisation process, to the horror of finding out he’ll have to keep the catheter in for a number of weeks, at least, if not longer. Vince suffers from BPH – Benign Prostatic Hyperplasia. He’s had drug therapies, surgical interventions, and they’ve all more or less helped, but a cure is beyond their remit and he knows he’s looking at ongoing work.
‘The latest thing was stapling’ he says, flapping his dressing gown, as if the mere thought of what the urologist did to him on that table needed releasing. ‘Can you imagine? Passing a probe up the urethra and stapling the prostate right and left. It’s pretty brutal. I mean – good grief!’
What makes it worse is that Vince is a fit, thoroughly independent man in his late sixties. A civil engineer, his whole life devoted to assessing, planning, coming up with solutions. The fact that he has to handover his care – his entire sense of self – to experts in a field he knows little about is obviously difficult for him. And now the catheter’s playing up again. Blood in the bag, pain in the penis. In and out of A and E. It should all be settling down by now. He’s doing all the right things. Nothing seems to work.

When I’ve finished checking him over and making my recommendations, we chat about other things, how he’s coping, his plans for the future.
‘It hasn’t helped with my wife being away,’ he says. ‘She’s tidying up her family’s affairs in Alaska’ he says. ‘I don’t know. We might move there. We’re both retired. It might work out.’
‘I’ve never been to Alaska. I’d love to go.’
‘Well – yeah – it IS amazing,’ he says, a little half-heartedly, as if he’s being forced to admit to something he didn’t particularly want to. ‘I like to see the whales.’
‘Do they get them there?’
‘Humpback. Beluga. Orca.’ He draws a breath. ‘It’s great to see ‘em. The humpbacks especially. They do this thing – breaching – where they rise out of the water in a spiral and then thump back down.’
‘What is that – a mating ritual?’
He shrugs.
‘There are theories. Could be play. Could be they’re communicating about food, or a warning. Who knows? Maybe they just like making a big ol’ splash.’
He manages a grim smile, gives his catheter a tug. ‘This’d slow ‘em down though,’ he says.

calamity june

~ jim clayton ~ Leave a comment

I ring Albert to ask if it’s okay to come round and see him. When he picks up I wait for him to say hello or something; when he doesn’t, I say hello instead – but then he talks over me, pretending to be an answer machine:
I’m sorry we’re not here to take your call, but quite frankly, we couldn’t be arsed. So if you’d like to leave your name and number and what you had for breakfast, then – please – do that, but don’t hold your breath for a reply, because quite honestly you’re not going to get one. Thank you very much, and goodbye…
I hear his wife June in the background saying Who is it, Albert? – a scuffling sound as the phone gets handed over – then: Hello? Who IS this?
‘Hi June. It’s Jim, from the hospital. I came round to see Albert the other day.’
‘Yes. Hello. Sorry about that. Albert does like to muck about.’
‘He probably thought it was a nuisance call. The number comes up as private.’
‘We get a lot of that.’
‘Me too.’
‘So what do you want?’
‘Is it alright if I come over and do Albert’s blood pressure again? The GP wanted a few days’ worth…’
‘That’s fine. Come over. It’s not as if we’re going anywhere.’

*

‘Sorry about earlier,’ says Albert, answering the door and shaking my hand. ‘I get a bit carried away sometimes.’
June is standing behind him, leaning against the doorway to the kitchen, wiping her hands on a tea towel.
‘I wish you would get carried away,’ she says.
‘Hark at that’ says Albert.
‘Well I thought it was great!’ I tell them both. ‘I always swear I’ll say something clever or weird next time we get a nuisance call, but of course I never do. I always end up saying Please don’t ring here again. Which is so pathetic it practically guarantees they will.’
‘I’ve had a lot of practice,’ says Albert. ‘I’ve always been a bit of a clown.’
‘Is that what you call it?’ says June.
Albert shakes his head, then turns and walks unsteadily to his favourite chair, lowering himself into it with exaggerated care. June follows behind, perching herself on the arm of the settee opposite, whipping the tea towel over her shoulder, then folding her arms. It’s difficult to figure June out. She doesn’t smile easily, and when she speaks it’s clipped and to the point. It’s understandable, though. The strain must be awful.
Albert and June are a retired couple in their late seventies. June is as fit as you could hope to be – as rootin’ tootin’ as Doris Day in Calamity Jane – but Albert looks twenty years older. He has a palliative cancer diagnosis, and he’s becoming frailer day by day. Symptomatically Albert’s steady, functioning at a reasonable level, the pain controlled pretty well, but the prognosis is bleak. It’s impossible to say when he’ll enter the End of Life phase. One month, six months, a year, two…. I’m not surprised June has her pistols drawn.

I run through the observations. At every point, Albert makes a joke. When I put the tympanic thermometer in his ear (The light’ll come straight out the other side); when I count his pulse (So I’m not dead yet?); when I pump up the cuff to do his blood pressure (Jesus Christ! You’ll have my arm off at this rate); when I scratch his finger for his blood sugar (That’s very nearly an armful).
June sighs heavily each time.
‘Just let him do his job,’ she says.
‘There! All done!’ I say, packing my stuff away.
‘A-one back to the front!’ says Albert.
June fold the tea towel into a square and smooths it flat on her knee.

When I’m ready to go, Albert insists on seeing me to the door. When he gets there, he turns and leans against it.
‘Can you give me some advice?’ he says.
‘Of course. What about?’
‘I don’t want my family coming round any more.’
‘Why?’
His chin starts to tremble. He takes a breath to steady himself, then raps his stick on the carpet a couple of times, summoning the will to speak.
‘I don’t want them seeing me go like this,’ he says. ‘I want them to remember me as I was. So what would you suggest I do about that, hmm?’
‘It’s hard,’ I say. ‘I know what you mean. But I think anyone who loves you would want to see as much of you as they could. I know I would. I think they’d find it hard staying away.’
‘Well. There we are,’ he says. ‘Thank you.’
I give his shoulder a squeeze.
‘Come and sit back down, Albert. I worry about you.’
‘I’ll be alright. I’ll keep on my feet if you don’t mind.’
‘Okay then. You take care. I’ll let the GP know what your facts and figures are.’
‘Thirty-eight, twenty-four, thirty-six,’ he says, then takes out a hankie and blows his nose.
June comes over and leads him back to his chair.
‘Close the door on your way out,’ she says.

home visit

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Charles Court sounds like a tabloid headline but it’s actually one of the smartest addresses in town. Even the approach is elegant: a shallow arrangement of steps and brass handrails, a decorative filigree canopy, wide, brass-handled glass doors, and swirling blue and white paisley tiling right and left – so that the whole thing looks more like the entrance to an expensive hotel than an apartment block.
I’ve actually come here to see two patients – a retired doctor with back pain on the sixth floor, and a newly catheterised patient on the fourth. I buzz the guy on the fourth, figuring I’ll work my way up, just as a snappily dressed elderly man carrying a deli bag walks up the steps towards me.
‘Excuse me, sir,’ he says. ‘Are you here to see Doctor Richards? I’m his friend and colleague, Doctor Samuels.’
‘Nice to meet you,’ I say, holding out my hand. He gives me the deli bag, which confuses me. We shake hands. I give him the bag back. Which confuses him. ‘Thank you,’ he says, immediately turning to walk back down the steps.
‘Aren’t you going to see your friend?’ I say.
‘What? Oh – yes! Yes, of course!’
He walks back up the steps, just as my patient answers the intercom.
‘Dr Samuels here,’ says Doctor Samuels, leaning pass me to answer in a gruff, doctorly kind of way.
Who? says my patient.
‘It’s okay’ I tell him. ‘It’s Jim, from the Rapid Response.’
With a doctor?
‘No. He’s visiting a friend. Another doctor.’
Oh says my patient. He mutters something. The door buzzes. We both go into the lobby.
‘Yes, yes,’ says Doctor Samuels. ‘Of course, we trained together, Doctor Richards and I. Saint Bartholemew’s, London. Nineteen fifty nine! Sixty years ago!’
He shakes his head sadly.
‘I’m seeing a patient on the fourth,’ I tell him. ‘But it won’t take long and I’ll be up to see Doctor Richards in about half an hour. Will you still be there, d’you think?’
‘Yes, yes!’ he says. ‘Now look. I want to thank you for all the marvelous work you do. It’s simply wonderful. We’re very lucky to have you.’
‘You’re welcome.’
‘I’m a doctor, too, you know. Well – retired! I’ve had my share of home visits, I can tell you!’
‘I bet you have!’
‘Oh my goodness, yes! I’ve been everywhere, seen everything and all stops in between. So I know what you’re up against and I thank you most sincerely for the trouble you go to. It’s much appreciated!’
‘Pleasure!’
We walk together across the thickly-carpeted lobby to the lift. I push the button. The doors slide open.
The lift is tiny – a sign of how old the place is, I would think. Dr Samuels is a portly guy in a huge mohair coat. He’s even wearing some kind of panama hat with a brim. In fact, if he hadn’t said he was a doctor I’d probably guess he was a Mafia Don. With all the bags I’m carrying, it’s going to be quite a struggle for us both to fit in. For a second I’ll think I’ll take the stairs, but then Dr Samuels says: ‘After you.’
‘Well I’m getting out on the fourth and you want the sixth so maybe you should go first.’
‘Please’ he says, pressing his eyes shut and gesturing to the lift. ‘I insist.’
It’s easier just to go along with it, so I say thank you and get in, putting my bags on the floor. Dr Samuels follows on, and we end up almost nose to nose. The doors slide shut, and for a moment we stand there, Dr Samuels with his eyes shut, breathing so heavily I’m worried he’s fallen asleep.
‘Excuse me…’ I say, struggling to reach around him to press the buttons.
‘Not at all! Not at all!’ he says, still with his eyes shut.
The lift judders up.
‘Ninety fifty-nine!’ I say, to make conversation. ‘That’s a long time ago.’
‘Yes,’ he says. ‘That’s when I went to medical school to start my medical training, you know.’
‘Is it?’ I say. ‘Amazing!’
‘That’s where we met, of course. Dr Richards and I.’
‘At Barts.’
He opens his eyes.
‘Yes!’ he says. Why? Were you there, too?’
‘Just a lucky guess.’
The door slides open.
‘Well. This is me,’ I say.
‘Thank you,’ he says, but even though I pick my bags up, he makes no effort to move. The doors slide shut again and we carry on up to the sixth.

‘Here we are!’ I say as positively as I can when the lift doors open again.

This time Dr Samuels does reverse out. I walk with him across the hallway to Dr Richard’s flat, just to make sure he gets there safely. I don’t want to be there when the door opens, though, because it’ll be embarrassing to have to explain why I’m not coming in just yet. My other patient is expecting me. I’ve confused things enough as it is.
‘I’ll be back up in a minute’ I say, heading for the stairs.
‘Why? Where are you off to?’
‘Down to the fourth,’ I say.
‘Marvelous!’ he says. ‘Well. Lovely to see you!’
He makes no move to ring or knock, but I hope for the best and leave him to it.
When I turn to look for the last time, he’s still standing there, idly rocking backwards and forwards. I wave, and he waves back with the hand holding the deli bag. Seems surprised to see it. Looks inside. Rummages around. Pulls out a sandwich. Starts eating it.

making up for lost time

~ jim clayton ~ Leave a comment

Leslie opens the door, mid-chuckle, like he was waiting there all this time to do just that.
‘Well come in! Come in!’ he laughs. ‘We don’t stand on ceremony here you know!’
I hold the door so he can let go, grabbing him when he almost plunges backwards into an umbrella stand, then holding onto him till he finds his balance again. ‘Thanking you,’ he says. ‘Must take more water with it. Er-hem. This way!’ He walks ahead, rocking from side to side, lifting his legs stiffly from the hip and working his arms, like a robot in an old sci-fi movie.
‘Through here!’ he says, as if there was anywhere else to go in the tiny flat, leading me into a sitting room with two armchairs conspicuously together in front of the television, one of them now being used as a place to put magazines and letters. ‘Sit where you like!’ he says. ‘’scuse the mess.’
Leslie’s doing well for ninety-eight. The only time his bright mood slips is when he mentions his wife, who died a couple of years ago. ‘We were a good team,’ he says. ‘I miss her a lot. It doesn’t seem fair. Still – that’s the way of the world! I’ll see her again soon.’
The doctor referred Leslie in to us for physio and nursing care, nothing too drastic. He’s pretty independent. Goes out most days – or did, before his fall. He has a son who lives a couple of miles away. Visits all the time.
‘My confidence got dented along with my pride’ Leslie says, squeezing his eyes together as he wipes his round glasses on his untucked shirt. ‘Still – I’ll find it again, don’t you worry! You can’t keep old chaps like me down for long!’ He puts his glasses back on and blinks at me happily. There you are! I can see who I’m dealing with now!’

*

When I’m done and writing up my notes, Leslie hands me a paperback he’s been reading – a history of the spitfire.
‘Any good?’ I say, flipping it over to read the blurb.
‘It’s alright,’ he says. ‘My son got it for me. I was a bit disappointed, to be honest with you. It doesn’t mention my lot at all.’
‘Oh yeah? Who was that?’
‘The One Five Two. Black Panthers. So called ‘cos we had a panther on the side, jumping over the roundel. I was one of the technicians, loading ‘em up, fixing ‘em when they went wrong – well, trying to, at least. Out in Burma.’
‘That must’ve been tough.’
‘We got through it. I remember one of the new pilots, South African he was. Tall, handsome chap. Big dimple in his chin, like Superman. He says to me one day, he says Sorry to trouble you old chap, but would you be able to do anything with this blasted watch? And he handed it over, and it was this big ol’ German thing, big as my head. Beautiful it was, a real precision piece. Lord only knows how he got it. Or how he lifted his arm when it was on. Anyway, he says to me he says The blasted thing’s losing time but it’s my lucky watch and I don’t want to fly without it. So I looked it over, but honestly I didn’t have the foggiest. I mean – half the time with dodgy instruments you just chucked ‘em out and replaced ‘em. Why they ever made me a technician in the first place is a mystery. So anyway, I give it back to him and I said Sorry squire! I think you’ll have to get it fixed in Berlin next time you’re over. So he took it back, and they flew out on a mission that night, and he never came back. And I think about that watch sometimes. I think if I’d have took it from him to fix, I’d probably still have it now. Not so lucky after all, was it?’
‘That’s quite a story.’
‘Don’t get me started,’ he laughs. ‘Change the record, that’s what Vera used to say.’
He seems to dip a little.
I tell him about Mr Burton, the guy who ran the corner sweet shop we used to go to on our way back from school.
‘He was this huge guy, big shining face, hardly any teeth, in a shopcoat with all the buttons straining and scuff marks down the front where he wiped the sugar off his hands. And used to stand at the counter with all these sweet jars behind him, rows and rows of them, breathing hard whilst we made our choice. Sherbet lemons, gobstoppers, aniseed balls, flying saucers – you name it. And whenever he weighed the sweets out from the jars, he’d pop one in his mouth. It was like: A quarter for you and one for me. A quarter for you and one for me. It was only years later I found out he was on the Burma railway. Just skin and bone when he got liberated.’
‘He was lucky to get out of that one,’ says Leslie. ‘Poor chap. It was a hard business, that’s for sure. He was probably just making up for lost time. Anyway – how’m I looking? A-one? Or a ticket home?’
And he gives his knees a vigorous rub, like he’s priming an engine or something, winding himself up, ready for action.

mad panda

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There’s a few of us gathered back at the office in the late afternoon, most of the day’s visits done, chasing the admin side of things, making referrals, further appointments and so on, waiting on the late jobs, the last minute visits, unforeseen events. It’s rare that it happens like this, a slack, re-grouping kind of time, when you’ve got the space to chat with your colleagues and catch up on things.
Magda is sitting next to me. She’s just had her hair cut – shaved close up one side, the rest in a heavy blonde fringe she scoots out of her face now and again. She looks tired but I don’t say it. Magda is the hardest working person I know. Not only does she pull extra shifts as a nursing assistant, but she works most weekend nights as door security on the clubs and bars in the city.
‘Man,’ she says. ‘I don’t think I can do it anymore. It’s not worth it.’
‘Why? What happened?’
‘Do you ever get those nights when you think – shit! Did I miss something? Did they fly a plane over town and pump it full of crazy spray?’
‘Did you get some trouble, then?’
‘Did I get some trouble? Yes, I got some trouble, thank you very much for asking. The funny thing was, they put me on the door of that comedy club you were talking about the other day. And I was thinking – okay, my only trouble here will be staying awake. But then these four guys show up, enormous guys, the kinds of guys who play rugby or some such shit, and I don’t know, bend girders for a living. Gigantic pain in the arse kinda guys. And when they turn up to the club they’re already pretty drunk. So I say to the bar manager, I say to him: Watch those guys and don’t sell them any more beer if they start getting too loud, y’know what I’m saying? They’ve already had too much. But of course, what do they do? They sell them plenty. And the next thing you know they start getting very loud and very aggressive, particularly this one guy, the biggest and tallest. So I go over to him, and I lay my hand on his shoulder like this, and I say to him: Can I ask you to please keep it down? Otherwise you’ll be asked to leave. And you know what he says to me?’
‘No. What does he say?’
‘He says fuck you.’
‘Wow.’
‘I tell you, man, I was like: Don’t you be saying fuck you to me! Who the fuck do you think you are, saying fuck you to me? And his friends are like: We’re very sorry. It’s his birthday. And I say I don’t care if it’s he’s won the Nobel prize for fucking CHEMISTRY. There’s no call to be so nasty to me. And then the other guys stand in front of him and they say: It’s just the beer. He’s not normally like this. He’s normally kind and quiet and basically a mouse. And I say: Well I’m sorry to have to tell you, but it’s not the beer making him a dickhead. The beer is absolutely fine. It’s your friend being a dickhead that makes him a dickhead. And the guy leans through them, and he says to me: Hey! You! You’re much too pretty to be doing a job like this. So I say to him: Keep your sexist opinions to yourself, my friend or you’ll see what this pretty girl’s capable of. Meanwhile all his stupid friends are crowding round saying sorry, sorry, sorry, please forgive him. And then the guy himself starts saying sorry, putting his hands together doing a pisshead kind of namaste. So I said: Okay. Okay. Against my better judgement, and because it’s your birthday, I’m gonna give you one last chance. And they’re all like thank you, oh thank you very much and everything. And I’m just about to go when I give the guy one last look and you know what he does? He flips me the middle finger. That’s it. I don’t wait for backup. I’m too mad and I’m too tired. I just grab him by the collar and march him out. And all his friends are jumping up and down saying sorry and he won’t do it again and please don’t, it’s his birthday. And you know what I say?’
‘What?’
‘I say Happy Birthday, Dickhead. Now fuck off and don’t come back.’
She sweeps her hair back from her face and takes a long drink of tea.
With her large round eyes, accentuated with dark blue-black eyeshadow and heavy black mascara, her pale face, and her sleepy demeanour, she reminds me of a panda. But even though Magda is a good friend of mine, and she’s used to seeing me around, still, I wouldn’t fancy getting on the wrong side of her. No way would I rile her up. I’ve seen how she crunches bamboo; I’ve seen what she can do with those paws.

drishti’s miracle

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Ella’s son John is furious. Not with us, he says, every now and again, like a cartoon bull kicking and raging around the ring, stamping his hooves, blowing smoke through his nose and ears – then stopping in a cloud of dust to bow to the rodeo clown.
‘Look at her! They may as well have fly-tipped her by the side of the fackin’ road. Like a fackin’ fridge or some’ink.’
‘I know it’s stressful, John, but just try to ease it back a little if you can…’
‘I’m not ‘avin a go at you, mate,’ he says. ‘It’s the fackin’ hospital. And the ambulance. I mean – what was they thinkin’? We’re back to square one. This is exactly the fackin’ situation she was in when she went in in the first place.’ He suddenly seems tangled up in all those ‘ins’ and stands there, breathing hard.
Even though John makes you want to take a step back, and maybe even pick up a cushion or something, I have to admit I can see his point. Ella is a bariatric, self-neglecting patient who’d been admitted after being stuck on the sofa for several days. And even though the flat has had a rudimentary ‘deep clean’ whilst she’s been away, it’s still pretty awful, and here she is, back on the same sofa. The two ambulance crews must have sweated and struggled hauling her in their carry chair up that crooked flight of stairs. And I suppose gravity and the relative height of the chair to the sofa must have worked sufficiently in their favour to make the transfer. But since we’ve been on scene to do the initial assessment and see what Ella needs in the way of therapy, nursing and care support, she hasn’t been able to get up, even with the most enthusiastic, hands-on encouragement. To all intents and purposes, John is right. She’s landed back where she started. If Ella can’t get up from the sofa we’ll simply have to send her in again, as a failed discharge.
It’s a difficult situation, made worse by the fact it’s already six o’clock in the evening. If we call for an ambulance they’ll mark her as low priority. We could be here till midnight.
‘Well I can’t stay,’ says John, reading my mind. ‘I’ve got my own family. I’ve got work in the morning. I’m fackin’ Hank Marvin’ and there’s fack all in the fridge. I mean – where’s the thinkin’? Where’s the planning? Hey? It’s fackin’ pathetic. I told ‘em this’d happen. I told ‘em exactly what’d happen. And what happens? This! This happens! Fackin’ unbelievable.’

I’m here with Drishti, the physio. I know how busy she’s been today, and lately. How much it would mean to her today to finish work on time and get home to her family.
‘There’s no point in us both staying,’ I say to her. Drishti is so essentially kind, though, she won’t have it.
‘No, no,’ she says. ‘Let us remain together and see what we can do. It’s never too late for a miracle.’

The thing I need to do with the most urgency now is redress Ella’s leg. She has varicose eczema. At some point she’s pushed the dressings down and been working away at the scabs. From time to time she reaches down, absent-mindedly pulls off another bloody scrap, and puts it in her mouth. It’s difficult to keep an eye on her to stop her doing it, especially with John ranting around the place.
‘Please don’t do that!’ says Drishti, gently guiding her hand back down and wiping it with a tissue. ‘It’s really not a good thing to do,’ she says.
I clean the leg with saline and re-dress it whilst Drishti calls for an ambulance.
‘Four hours minimum’ she says with a sigh, hanging up. ‘They say it is a busy night. When is it NOT a busy night?’
‘I don’t suppose you’d be able to stay with your mum…?’ I say to John.
‘What? You’re havin’ a laugh, mate? Four hours? I’ve been ‘ere too fackin’ long already. I’ve got my own fackin’ life, y’know?’
‘Has you got anyone else? Any siblings?’
‘I’ve got my sisters, but they’ve washed their hands. They don’t want to know.’
‘What about friends? Neighbours?’
‘There’s no-one. That’s what I told ‘em! She hasn’t been out o’ the flat in seven years! I fackin’ told ‘em all this! I can’t stay, mate. I gotta get up early.’
‘Okay,’ says Drishti. ‘That’s fine. You can go.’
And it’s only when he turns to hurry out of the door that she gives me a steady, sorrowful look.

I call the office to let them know what’s going on and to see if they have any brilliant ideas.
Lawrence is co-ordinating.
‘Ah!’ he says. ‘Oh dear. Erm….Well! Yes. I see the problem.’

If I’d written a film script set in the eleventh century, and there was a scene where a troupe of marauding knights were riding towards a monastery, and the monks were frantically running around, and one of them, a particularly tall and ascetic looking monk, was desperately loading up a cart with armfuls of ancient books and scrolls and things, tripping over his habit, cursing mildly, and then the ass gave a jolt and a wheel fell off, splashing the monk head to sandals in mud, just as the knights came clattering into the yard, swinging their swords, and the monk turned to deliver his line straight to camera: ‘Well. Isn’t that just bloomin’ typical!’ – I’d be sure to cast Lawrence as that monk.
(He already has the haircut).

‘Oh dear!’ he says. ‘Damn and double-damn. Okay. Right. Well. I suppose I could relieve you when the office closes. If you like? I live nearby, so it wouldn’t be so bad for me…’
‘That’s kind of you, Lawrence,’ I say. ‘Maybe it won’t come to that.’
I tell him we’ll keep in touch, and ring off.

We settle in – as best we can, given the environment.

Ella says she’d like to watch some TV. We give her the remote and she flicks through the channels, eventually landing on a reality show about a couple looking to buy a house. They’re standing on a terrace overlooking a fiercely blue harbour dotted with yachts.
‘You won’t see that in Bradford,’ the presenter says.
The couple smile but they look uneasy, shielding their eyes from either the sun or the presenter, it’s hard to tell. I suppose the idea is they could live anywhere. Maybe the next place they show them will be underwater or something.
‘That looks nice’ says Drishti. ‘Hot, you know?’
Suddenly a mobile phone rings somewhere. Drishti locates it in Ella’s hospital bag. She hands it to her.
‘Hello…?’ says Ella, still watching the TV. ‘Yeah. About an hour ago…’
I raise my eyebrows.
‘Ella?’ I say. ‘Sorry to interrupt. Would you mind if I had a quick word with them?’
‘It’s the nurse’ she says into the phone. ‘Okay. Jes’ a minute…’ She hands me the phone, then leans to the side to carry on watching the TV.
The caller is a woman called Stella. She works for a befriending service. Apparently Stella had been expecting Ella home and was planning to come round to see she had everything she needed and so on. I explain the situation, and ask if Stella might be able to stay a little longer until the ambulance arrived.
‘Medically she’s okay,’ I say. ‘It’s just she needs someone to keep an eye on her.’
‘That’s fine’ says Stella. ‘No problem. I’ll be straight round.’
‘Thank you so much,’ I say, then hand the phone back to Ella.
‘Who was that?’ says Drishti.
‘That was your miracle!’
I go to the window, draw the net curtains aside, and look out at the night sky, fully expecting to see a star detach itself, glide gently and magnificently down to earth, hop pointedly across the lawn, and ring the bell.

ETOH

~ jim clayton ~ Leave a comment

It’s quite a contrast to see the two of them together – Alex, wraith-like, matted hair, scooped eyes, shivering, hugging his legs in bed with a filthy duvet piled up around him; and Graham, the support worker from the alcohol and substance abuse team, shaven-headed, gym-fit, in a smart grey reefer jacket and leather man bag, perched on the arm of the sofa with his hands in his pockets. It could be a fashion shoot for an edgy magazine.
‘You’ve got this far, yeah?’ says Graham. ‘Hats off to you, mate. It’s no easy thing you’ve done there. Don’t go and spoil it now. After all we’ve been through. You got to realise – this is a disease we’re talking about, yeah? There are all kindsa toxins and shit floatin’ around your body right now. You can’t just expect to jump up and be cured. It’s a long, hard process. And you’re doin’ great, man! Isn’t he? This guy’ll tell ya…’
‘You are. Graham’s right. Alcohol addiction’s the hardest thing.’
‘See what I mean?’
Alex doesn’t seem convinced. He draws his legs closer to him, gives his head a peremptory shake.
‘I don’ know, man. I jus’ feel like I’m wastin’ everyone’s time. I mean – I brought it on myself.’
‘You can’t afford to think like that,’ says Graham. ‘Everyone’s different. You’re totally worth it, man.’
‘Is there a social worker involved?’ I ask Graham, flipping through his folder.
‘No,’ he says. ‘When they see they’re still drinking they pull out.’
He shrugs, scuffs his shoes in the trash.
‘It’s hard, but it’s just the way it is.’
‘It’s not like I’m not trying,’ says Alex.
‘Yeah – but there’s trying, and there’s doing, Alex. You’ve got to be in a position to accept the help. It’s just how it works. You know that.’
‘Yeah.’
‘We’re here for you, though.’

There are several bottles within easy reach of Alex’s bed – a two litre bottle of cider, a couple of quarter bottles of vodka, some other, less obvious stuff in bottles with the labels torn off. A dull yellow light filters through the filthy windows. The flat is an apocalyptic mess; it looks like an extemporary shelter somebody hollowed out with their hands in a landfill site. Here and there you can just make out traces of the orderly life Alex once used to live. There’s a mountain bike in the hallway, quietly fossilising under a press of junk; over by the window-ledge, a tool box, some work boots.
‘We’ve got to find a way to keep you out of trouble long enough to detox properly,’ says Graham. ‘Yeah?’
‘Yeah,’ says Alex. He doesn’t sound convinced.
Graham shrugs, pushes his hands deeper into his jacket.
‘How long’ve we known each now?’ he says. ‘Gotta be nine, ten years.’
‘Is it?’ says Alex, rubbing his face. ‘Fuck, man! Nine years? No! That’s like…’ He screws up his face to figure out what percentage of his life that represents: ‘…that’s like… a fuck of a long time, man!’
‘I think so,’ says Graham. ‘First time I met you you’d just been beaten up and taken to hospital. You were in a bad way, my friend.’
‘Was I?’ says Alex. ‘I don’t remember.’
‘Yeah – well – you don’t remember much, to be fair. You didn’t remember I was here yesterday, so maybe that’s not headline news.’
‘No. You’re right. Probably not.’
‘I’ve seen you in and out of hospital a hundred times. Lost sight of you for months on end when you took yourself off somewhere. You’d always turn up again, half dead, some new injury. And now look.’
He’s right. I’m reading through the latest discharge summary. For someone so young, Alex has a terrible list of things wrong. In fact, it’s a miracle he’s still here at all. Looking at him on the bed, though, it would be easy to think that maybe he wasn’t – that maybe he’d died that last time in hospital, but his spirit was so cussed it dragged itself back across town to find rest in this cold, cold bed.
‘It’s like training, yeah? You can’t just jump on a treadmill and bang out ten K. You might feel great at the end of it, but the truth is, if you don’t get the intervals right you can be setting yourself up for a lot of trouble. It’s all about the interaction between the sympathetic and the parasympathetic nervous systems, the way your body metabolises the shit and tries to get straight again. Jim’ll tell you. Hey?’
They both look at me – Graham as if he’s about to pick me up and bench press me, Alex with a haunted, shivery look.
‘That’s right,’ I say, ‘Uh-huh.’

the works

~ jim clayton ~ Leave a comment

There’s a builder’s truck blocking the mews. It’s up on hydraulic stabilisers as the driver operates the winch, dropping off enormous bags of sand and gravel, the engine labouring as the next load gets taken up, the back of the truck lurching with the sudden change of weight. I can’t imagine what building project would require such a massive delivery – maybe one of those basement excavations you read about, an underground pool and cinema and gym, perhaps. A lift shaft to a cocktail bar and viewing platform at the earth’s core. Whatever the reason, the contrast with the ancient backstreet couldn’t be more extreme. Two hundred years ago these would have been a row of stables with offices, lofts and basic accommodation above; now they’re a mixture of chi-chi businesses, full-scale conversions, and the cobbled street curves down right and left not to straw and manure-heaped gutters but expensive planters, artisanal signs and cutely painted old bikes with geraniums in the basket.

We’ve had to park at the far end by the equipment van that’s here to deliver a hospital bed. They could only have beaten us by fifteen minutes and yet they’re already half-way through. Once again I’m in awe of their efficiency and sheer work ethic, like scaled-up ants in yellow jackets. A hospital bed is no light thing. It comes in sections, of course, but the main frame is pretty heavy. A feature of the flats in these mews is a steep and narrow staircase running straight up from the front door – no doubt originally to a hay loft. To make things even more awkward, the house we’re visiting has a stair lift, so really there’s hardly any room at all to get the bed in. When we stroll up, though, they’ve already got the frame delivered, and all that’s left are the mattress, a cantilever table and a few other bits and pieces.
‘What did you do – commandeer the truck?’ I say to one of them, who is so red-faced I want to lean in and loosen his collar.
He laughs, slicks his antennae back.
‘Maybe you could take the table?’ he says.

The whole thing is something of a rush job. The GP had visited George late last night. George is a ninety-five year old man with a recent palliative diagnosis who has declined rapidly and unexpectedly straight into an End of Life scenario. He was refusing hospital, so the GP had prescribed anticipatory meds, made referrals to the District Nurse and Palliative teams, and to us for urgent review first thing in the morning. Katrina had gone straight there from home and was busy by eight. By nine she’d phoned in to make her report: it was bed care only, so George needed a hospital bed with pressure mattress and slide sheet to be delivered the same day, with someone to be there to help with a pat slide; George needed care support four times a day, double-up; he needed pads, pressure cream, foam lollipops for mouth care – the works. I said I could meet Katrina there at lunchtime to get the whole thing done.

George’s wife Valerie greets us at the top of the stairs.
‘Forgive my hair,’ she says, patting it. ‘I must look a fright. But as you can imagine I’ve had quite a night.’
Both Valerie and the flat have the shocked look of something hit by lightning. Everything is essentially as it was – the pictures, the chairs, the collections of antique pill boxes and books, the Moroccan rugs and tables and lamps, the family pictures on the walls – everything so perfectly placed and orderly the housekeeper must have a tape measure in their pocket. But the furthest end of the flat – the main bedroom end – has a sprawled, disrupted appearance, with a wreckage of discarded packaging, plastic strapping and so on spilling across the hallway, whilst through the open door the sound of construction and the movement of heavy furniture adds to the feeling of emergency. The noise from the builder’s truck outside sounds like a fire engine.
‘What a business!’ says Valerie. ‘But you know, everyone’s been so kind. We really are most grateful.’

There’s a large tabby cat staring at me from the middle of the living room rug. It’s as perfectly groomed as Valerie, and I half-expect it to reach up with a paw and pat itself delicately on the head, as she did.
‘Grammaticus is very put out,’ says Valerie, walking over to him. ‘He’s nineteen, you know? Like us – old and worn out. He can’t tolerate the fuss.’
She bends down stiffly and painfully, scooping him up to cradle him in her arms, just exactly as you would a baby, pressing her nose to the top of his head, rocking him up and down, swinging her hips a little from side to side. He maintains his stare, making little adjustments to accommodate the motion.
‘He looks good for his age,’ I say.
‘Do you think?’ she says. Then – still rocking the cat – she looks off towards the window. Down in the street, the noise from the builder’s lorry has eased. It sounds as if all the deliveries might have finished, and instead there are shouts and raucous laughter, the plaintive whining of hydraulic legs being lifted, the off-kilter clattering of a concrete mixer.
‘Good God,’ says Valerie. ‘When will it all end?’

holy bananas

~ jim clayton ~ Leave a comment

I’m sorry to have to say this, but it’s all Pete’s fault.

‘There you go! Thought you might want something big and hot inside you!’ he says, slopping a huge Arsenal mug of builder’s strength tea onto the desk, then walking off, laughing in that filthy way he has, high and wild and raucous as a drag tea lady in a pantomime.

Pete is the world’s best tea maker – a county-level performer, meticulous, prolific. It doesn’t matter how much I resolve to be the first in with the drinks round, somehow he always manages to beat me to it. It’s in his blood. His DNA sequence is PGT. His mother was a teapot and he was born under the Constellation of the Great Urn. If you x-rayed his torso you’d see two tea bags where his kidneys should be. Pete is the Caffeine King, the Tannin Chief, the author of the Beverage Report. He put the tea in terrific and the milk and two in you. And so on. I have no doubt one day they’ll raise a statue by public subscription (mostly funds re-streamed from tea clubs across the world). A life-size bronze in the marketplace: Saint Peter of the Kettle, mug raised high for seagulls to perch on and provide the laugh.

Anyway. Nobody’s forcing me, I don’t HAVE to drink it. I know it’s going to be a busy morning so if I finish the whole mug I’ll be busting for the loo half way through. But Pete’s tea isn’t something you can pass over easily. Rational thinking doesn’t come into it. By the time I’ve left the department to start my visits, the mug is empty. I rinse it clean, put it upside-down on the draining board, and leave.

 *  *  *

By the time I get to Ralph, my second patient, my bladder is as taut as a helium balloon with Arsenal printed on the side. I finish dressing Ralph’s wound, doing his obs and so on, and I’m just about to ask him if it’s okay if I use his loo, when he says his daughter is due back any minute. She’s just popped out to get a repeat script of antibiotics. I don’t want to be in the loo when she comes in because I think it might look odd. But then I think – maybe it doesn’t matter, because I remember there’s a rehab unit in the next street. They have toilets there. I can use them. Everything’s fine. I pack up my things, say goodbye to Ralph, and leave.

It’s only after I’m parked up and walking to the unit that I realise it recently closed. (A political decision; don’t get me started). But there’s a car parked outside, and I think maybe there’ll be people there packing up or something – even just a security guard. In fact, standing up against the door and shielding the glass with my hand, I can see a mug of tea (how ironic) and a fluorescent jacket dumped on the counter. I ring the bell, knock, ring again. No-one comes. I’m tempted to find some nook or cranny, somewhere discreet I can go without being seen. But I worry the security guard will suddenly appear, doing their rounds, and besides, the unit is surrounded by flats that overlook the place as closely as watchtowers round a prison.

My next visit isn’t for another hour – a double-up with a physio at The Pines, an extensive, sheltered housing place the other side of town. I decide to get there early and use the visitor’s toilet.

The Pines is a busy, friendly block. There are always residents sitting in the gardens, wandering in and out, things going on. A manager in the office. Today, though, it’s eerily quiet. The fact that it’s Sunday means there’s no-one on duty. The weather is bad, sharp and autumnal, so no-one’s sitting out. I can’t buzz the patient’s flat – we’re doubling-up because they have a history of mental health issues and need careful handling. All I can do is wait to see if anyone appears in the lobby. After ten minutes of nothing, I buzz the remote site office. Eventually, after a twenty millilitre pause, they answer. I explain my predicament, trying to sound as warm and authentic as I can.

‘Well – as we have no camera on the door…’ the voice says, ‘… and there’s no way of verifying that you are who you say you are, I have no alternative but to say no. I’m sorry. Goodbye and good luck with all your endeavours.’

The intercom clicks off.

I rest both hands flat on the console, wondering whether to buzz again and try begging. Then I pick up my bags and hurry back to the car. I figure if I drive fast enough I can just about make it back to base, use the loo, then turn around and drive straight back in time for the visit.

For some reason, there is a stationary queue of traffic on the road heading in. I’ll never get there at this rate. I see myself exploding behind the wheel like a hyper-inflated space hopper, and when the emergency services force the door they’ll jump back in horror as my idiotic grin floats out on a torrent of piss.

As soon as I can I make a u-turn and head back to The Pines. It occurs to me that there’s a clinic just round the corner from it: they’ll definitely have a public loo. I can use that, then relax for twenty minutes until the appointment.

I’m forgetting it’s Sunday. Of course the clinic is closed. There are plenty of attractive bushes in the landscaped quadrant just in front of it, but unfortunately they’re overlooked by a community hall, and in the hall are lots of elderly people gathered together for a meeting of some kind. I toy with the idea of banging on the window and asking if they’ll let me in to use their facilities, but it’s just too public and humiliating, so instead I go back round to the main entrance of The Pines, hoping beyond hope there’ll be someone to let me in this time.

There is. An elderly man in a black felt, flowerpot hat, wearing so many disparate and ill-matching clothes it looks like he’s put on everything in his wardrobe at once, for a bet. He is sitting on a bench in the foyer facing the doors, methodically peeling a banana. I stride up to the doors, smiling as warmly and reputably as I can. Put my ID card flat against the glass. Wave and nod for him to come over.

He takes a cautious bite from the very tip of the banana, and stares at me.

I wave at him again, going through such a pantomime of encouraging shrugs and winks and nods I must look crazy.

He takes another bite of the banana, then carefully replaces the skin flaps – one, two, three, four – like he wants to fool someone into thinking it’s an untouched banana. He places it on the bench beside him, stands up, brushes the front of his mac, licks his lips, touches the corner of his mouth with his finger – first the right, then the left – repositions his hat – then makes the four thousand mile journey across the carpet towards the door. I hope he might come via the big silver door release button on the wall, but instead (and – to be fair to the man – quite correctly) he walks in a straight line to the door and pushes his face up close to the glass to read the card, his banana breath fogging on the pane. Then he looks round the side of the card and glares at me. I smile. He looks back to the card again.

‘I’m early for an appointment,’ I say, overly pronouncing my words in an effort to be heard. ‘I’m waiting for my colleague so we can go in together. The thing is, I’m desperate for the loo, and I wondered if you could let me in so I can use the facilities?’

He raises his eyebrows, lowers them again, turns around, and starts walking slowly back. For one, terrible minute I think he’s just going to sit down and carry on eating his banana, but at the last minute he changes course and touches the silver button. The doors slide open.
‘Thank you SO much!’ I say. ‘I can’t tell you how much I appreciate that!’

He shrugs, waves his hand in the air. I hurry round the corner to the loo, and a few minutes later float back out.

The old man has gone. He’s finished his banana and left the skin of it on the bench. It’s peeled into four large petals, white flesh up, yellow skin down, like a sloppy lotus flower blooming on the green baize. It’s a rapturous image. A holy relic. I could kneel before it, kiss it, put it on display in a glass box.

But I don’t. I’m over it. I throw the peel in the bin, and head back out to wait in the car.