sketches

the white handkerchief

~ jim clayton ~ 2 Comments

As diagnoses go, it sounds pretty gentle. Mixed Dementia. Like a mixed fruit salad. Mixed bathing. A bag of mixed nuts. Casual, essentially benign.

There’s nothing benign about Mixed Dementia, though. Its devastating effects would be more aptly described as Dementia Plus, or maybe Dementia: Perfect Storm.

Joe has Mixed Dementia. To date he hasn’t been too bad, functioning at a reasonable level. Although he’s permanently confused, he tends not to get agitated. Most of the time he sits neutrally and quietly in his favourite armchair, going along with whatever his wife Joan wants him to do. He’s been able to mobilise reasonably well, steady enough on his pins for Joan to manage washing and dressing him on her own. He’s barely on any medication, so that’s not been too much of a problem either.

Unfortunately – for Joe, Joan and the rest of the family – his condition has taken a downturn, particularly his mobility. There’s a Parkinsonian aspect to it these last few weeks. He lists alarmingly to the left when he stands up, leans back to compensate, and if that wasn’t enough, his left leg gets stuck when he tries to move forwards. The result is that Joe’s been falling every day. Luckily for Joe he’s avoided hurting himself; unluckily for Joan, he landed on her a couple of weeks back and fractured some ribs.

The last fall was this morning. An ambulance attended, checked him over. His obs were as steady as ever. (‘He’s fitter than me’ says Joan, dabbing at her eyes with the white handkerchief embroidered with flowers she’s been playing with all this time. ‘Aren’t you darling?’ – Joe directs his grey-blue vacancy in her general direction; they share a hesitant smile; she loses herself in the handkerchief again). There wasn’t anything acute that needed hospital admission. The ambulance crew liaised with the GP, and then the GP referred Joe to us to see what we could do.

The obvious and most immediate thing is to get Joe a respite bed in a nursing home. The trouble is (always the rider these days), he needs an assessment by social workers first. They’re short-staffed, so a delay of a few days even for priority cases is unavoidable. Then, as Claire the duty social worker explains to me, there may not be any beds available. ‘Not much capacity in the system at the moment,’ she says. ‘Best case scenario – a week, maybe two.’
She sounds exhausted.

I’ve spoken to the GP. He tells me there’s been a multi-disciplinary meeting (the outcome of which hasn’t been communicated to the family yet, helpfully). The consensus is that Joe’s mobility problems are symptomatic of his worsening dementia. ‘It’s a palliative scenario,’ says the doctor. ‘And really, if his care is no longer tenable at home, we’ll have to start looking for a residential placement somewhere. We just need time to make that happen.’ We agree that our service can try setting up a micro environment to minimise the falls risk; to send in carers four times a day – for moral support if nothing else; a night-sitter at night to give Joan a break; nurses to keep an eye on things, and generally case-manage until the social workers can come up with a placement.

I’ve put this plan to the family. It hasn’t gone down well.

‘Look at us! We’re at breaking point. Honestly – this is hell,’ says Emma, the daughter. Her face is puffy and her eyes red. She’s struggling not to cry, especially now that Joan has her face buried in the handkerchief. ‘Look at her!’ she says. ‘She’s done her best but she’s at her wits’ end! We can’t go on like this.’

As gently as I can I go over the options, which at this point seem to boil down to two: stay at home with whatever support we can offer, buying the social workers time to find a residential placement, or go to hospital.

‘And sit around in A and E for hours?’
‘I’m afraid so. That’s where everything’s triaged.’
Emma looks at her mum.
‘This is what you get,’ she says, bitterly. ‘You struggle through. You take care of things as best you can. And no-one cares. No-one’s there for you. Maybe Dad needs to have a bad fall and really hurt himself, and then maybe someone’ll listen.’
‘I don’t want Joe to go to hospital, but I can’t cope with him anymore at home,’ says Joan. She gives me a despairing look. ‘What would you do if this was your dad?’
‘I don’t know. I’d try to think what was best. It’s hard to say.’
She sighs, then directs her attention back to the handkerchief.
‘What would you like to happen, Joe?’ I say, leaning forward and stroking his hand. He says a few random words, but it’s impossible to know what he means. His tone is light and disengaged. At least he’s spared the emotional trauma of all this.

I’ve been here two hours already. I’ve spoken to the social workers, the GP, the nurse in charge back at the hospital, but despite all the facts, all the reassurances and negotiations, the essential problem remains.
‘Okay,’ I say. ‘I’m sorry this has been so difficult for you. Something needs to happen now, so let me make the decision for you. Joe isn’t safe here at home. He’s highly likely to fall again, regardless of the things we might manage to put in place. I can see how exhausted you both are. It’s a terribly stressful time and I think you’ve done a wonderful job. Going to hospital isn’t ideal, but it’s the safest option. I’m going to call for an ambulance to take Joe to hospital on a four hour response. At the very least that’ll buy everyone some time to rest and get things sorted. Okay?’
I pick the phone up to dial.
‘Is the patient conscious and breathing?’ says the call taker.
‘Yes,’ I say, smiling at Joe.

Joan buries her face in the handkerchief again.

the wrecking ball

~ jim clayton ~ Leave a comment

I knew the street – or thought I did. A utilitarian cut-through in an older part of town, with the sort of uniform civic redevelopment it makes you wonder whether the original buildings fell victim to town planning or the Luftwaffe. The street is dominated on the leading corner by a long, low, smoked glass office building, leading on to other, smaller offices, a single, more original building in a rotten-looking antiques warehouse – mobile phone number painted on the peeling double-doors where the cart used to go in and out – and half way up, a pristine meditation centre, operating out of the old telephone exchange, finding new ways to make connections.

Giles’ block is narrowly squeezed-in, set-back, anonymous, thrown together from the same Lego tin as its neighbours. The only thing that gives it away as a private address is the scrappy intercom console, the names of the people who live there scrawled in marker pen, stuck over with tape or missing completely. Two office workers vape and sip coffee, leaning up against the black pointed railings to the right. They’ve both got such perfect, Edwardian-style beards and moustaches, it’s a shame they can’t get vapes designed like long clay pipes. Before I can suggest it, Giles buzzes me through.

If the exterior of the apartment building looks flimsy and plastic, the conversion inside is even more extemporary. It looks so thin, if I tripped and put out my hand to save myself, no doubt all the walls would tumble down one against the other like a pack of cards, until I was left standing in the shell (with the two bearded vapers peering in at the window).

Giles’ door shows signs of a forced entry. I know he was admitted to hospital after an overdose, so I’m guessing that’s what it was. It wouldn’t have taken much putting-in, that’s for sure. A butterfly could’ve done it. With an ant as a battering ram.

No need for that today, though. Giles is waiting for me in the doorway. He’s gigantic – much too big for this place – a vast, fleshy monolith of a man, wearing an old Motorhead t-shirt and cut-off trackie bottoms. When he turns and leads me into his flat, his left shoulder slightly higher than the right, his palms swipe backwards to help him along, like a polar bear paddling for purchase in the floes. The whole building bounces.

His living room is a mess. There’s one armchair in the middle of it all, blackened and sagging in the middle. When Giles sits himself into it with a thundering sigh, he’s almost completely subsumed, like he’s dropped himself down into the maw of a particularly giant and noxious kind of fungus. He spreads his fingers on the arms – to stop himself disappearing straight through the floor, probably – and regards me with a baleful look.
‘What’s all this about?’ he says.
I explain what the team is and the things we do.
‘I’ve come for the initial assessment,’ I tell him. ‘It’s a formality, really. I think you’ve been referred to us by the hospital for very specific things. For physiotherapy – because I think you injured your shoulder? Is that right? And for some bridging care, to help you get back on your feet. Unless you think there’s any equipment you might need?’
He raises his eyebrows.
‘What do you mean? Equipment?’
‘Well – in the loo, for instance. To help you get on and off. Given your shoulder problems. To make sure you don’t have any more falls.’
‘I fell because of the overdose’ he says.
‘Yeah. But still…’
He gestures behind me.
‘Be my guest. See what you think.’
‘Okay.’

What I think is that the toilet is as terrible as the rest of the flat. I imagine the gateway to Hell might look similar – although I’m sure even Satan would be a bit shamefaced and throw something down there. The only equipment this place needs is a wrecking ball.

‘Hmm,’ I say, going back in to the living room. ‘Maybe I’ll get the OT in to see you after all.’
Giles nods and smiles.
‘I’m sorry,’ he says, making an effort to get up again, but defeated almost immediately. ‘I haven’t offered you tea.’
‘That’s kind,’ I say. ‘But it’s fine. I just had one.’
‘As you wish,’ he says.
We smile at each other.

coffee & cats

~ jim clayton ~ Leave a comment

Magda bangs the horn with the heel of her hand, the force of it pushing her back into the seat.
‘Fucking hell! Would it kill you to indicate? How we supposed to know what you going to do at roundabout? What do you think I am? Fucking mind-reader?’
She drives on.
‘My father used to be traffic cop. He made it big thing to learn. He say to me “It doesn’t matter if it’s one, two, three o’clock in morning and no-one on road for miles. You make manoeuvre, you indicate. Because this way it becomes automatic habit, and you do it whenever you drive, without thinking.’
She’s forced to give way to an oncoming car.
‘Jesus fucking bastard! Sorry – I know is bad to swear. But please! Where these people learn to drive? Fucking CLOWN school?’

* * *

One of our carers has gone sick, so I’ve been asked to help Magda out with a double-up call. It’s to Rita, a very elderly and frail woman who has deteriorated significantly in the last few days. The regular care company don’t have capacity to pick up the increased calls yet, so we’ve stepped in to bridge the gap.
‘Rita is lovely woman,’ says Magda, pushing her enormous sunglasses up into her bleach blonde hair. ‘But then you see, I only do lovely womans.’
She jabs at the keysafe with one hand and retrieves the keys without even seem to look, everything so slickly done it’s like watching a stage magician.
‘Rita has lovely cat,’ she says, opening the door. ‘But she is grumpy in morning, like you. Helllloooooo? Rita? It’s the carers, darling. Good morning. We’re coming up there…’

I follow her up the stairs into a large, dimly lit sitting room with a hospital bed at one end. Rita is lying in the bed, surrounded by cushions and bolsters, the mattress raised in the middle to crook her legs up. She turns her head to the side to smile at us, the skin beneath her chin spare and slack, her whole body giving the impression of a generalised falling away, as if life was a tidal force leaving her now, declining with the last phase of the moon.

Almost immediately there’s an imperious yowling sound, and an enormous black cat stomps into the room behind us. The cat is wearing an expression so furious you could simply draw an X with a marker pen and be done. She advances into the middle of the carpet, sits on her haunches with an audible plump, licks her lips once, and waits.

‘Here is cat!’ says Magda, to avoid any confusion. ‘I’m sorry, I forgot already. What is cat called?’ she says to Rita, who manages to say without any interruption to her smile that the cat is called Juniper.
‘Juniper? Huh. I thought was Jupiter. Juniper? Like berry? Is this what you call it, berry?’
I nod.
‘They use it to make gin,’ I say. ‘I think that’s where the name comes from.’
‘Juniper?’
‘I think gin is short for ginevere or something. Dutch maybe. Which means juniper.’
‘Huh.’
She turns to Rita.
‘You like gin, Rita? Is that why you name your cat Juniper? Maybe you have other cat called vodka?’
Rita closes her eyes and shakes her head imperceptibly.
‘No worry,’ says Magda. ‘Let us sort you out, darling…’

* * *

After Rita is freshened up, the sheets changed and everything taken care of, Magda plays with the cat whilst I write up the notes. Magda knows where Juniper’s toys are kept; straightaway she fetches a small plastic fishing rod with a crinkly bee on the end of a string and dandles it in the air above Juniper’s head. Juniper swats at it – a little half-heartedly, it seems to me, flashing me looks now and again as if to say: Look – I’ve just got to attend to this damned bee business and I’ll be with you directly.
‘What is matter with you today, cat?’ says Magda. ‘Is my friend here distracting you? Is that what it is? Hmm?’ She gives up, tosses the rod on the sofa, and subjects Juniper to one more colossal stroke of the head and neck – so vigorously that as a matter of survival, Juniper has to stand and brace herself with her front paws, raising her tail straight up in the air to deflect the energy into the ceiling.
Magda picks up her bag to go.
‘I love this funny cat, Rita,’ she says. ‘We have cat back home, Puszek. But he is farm cat. Like baby tiger, you know? Puszek is so big now he drive the tractor.’
Rita bats a skeletal hand in the air.
‘Okay, darling,’ says Magda, taking Rita’s hand and squeezing it. ‘You take care now. We see you later. Okay? Okay. And don’t worry. We put key back in key safe.’
Juniper jumps up onto the bed, and immediately begins paddling on the duvet with its paws.
‘Good girl,’ says Magda. ‘That’s it!’

* * *

On the way back to base we stop off for a coffee and something to eat. We take five minutes to drink it in the car before setting off again.
‘How old are you?’ she says, giving me a sideways look, twisting the lid off her cup and blowing across the top of it.
‘Fifty-six.’
‘Fifty-six? Jesus Christ! You could be my father!’
I shrug.
‘You don’t look fifty-six,’ she says, biting the end off a croissant and chewing vigorously. ‘What you do before this job?’
‘Well – I was ten years in the ambulance. Before that I was teaching English in a secondary school for a couple of years. Before that I was temping. Different companies, some for a couple of years. I worked for a publishing house in London. A warehouse, office jobs, a couple of bars. I went to university, did English and Drama there.’ I shrug, helplessly. ‘That kind of thing. You know?’
I want to tell her I tried acting for a while, but I imagine it would just add to the generally dispiriting account of my career to date, so I leave it out and sip my coffee instead.
‘You travel?’ she says.
‘No. Not really. I wanted to.’
‘No travel? What about drugs? You do drugs?’
‘Some. Not much.’
‘Hmm,’ she says, finishing the croissant, smacking her hands clean and turning the engine over.
‘You’re telling me, not much. Come, now. Done. Let’s go.’

the wave

~ jim clayton ~ Leave a comment

On the side of the kitchen cupboard that faces the door there are a series of lines, marking the changing heights of all the kids that lived there. It’s a steady progression, up and up and up, levelling off I’d guess in the teenage years, except for one line way above the others – a good few feet, almost at the ceiling.
‘Jesse did that’ says Ange, laughing. ‘He stood on a chair. Although – to be fair – he probably didn’t need to.’
Bill, the father to all these kids, is sitting impressively at the kitchen table, quite possibly the very chair Jesse used. He’s still and watchful, with a head of hair and beard so full and pure and white it’s like watching snow clouds gather on a craggy peak.
‘I don’t like all this,’ he says.
‘I know, pops,’ says Ange, giving him a squeeze that he tolerates stiffly. ‘I know. But it’s like we said. Remember? Things have got to change. You’re not as young as you used to be.’
She looks at me and smiles. ‘Let’s face it. None of us are.’

It’s an eerie feeling, sitting in that kitchen. At one time it must have been the centre of the house, the first and main room commanding the hallway, which itself leads off into a honeycomb of other rooms. Spilling down into the hallway is a bare, broad staircase whose handrail and boards are smoothed from decades of hands and footsteps. Everything is shadowy, now. Haunted – and quiet, too, with that deep and settled kind of quiet that makes your ears ring.

There’s a knock on the front door. Ange gets up to show in a couple of guys from the equipment department who’ve been tasked to fit a handrail up the stairs on the other side. They get straight to it, and soon the old house rattles with an intensity of drilling and shouted instruction.

Bill winces, directs his attention out into the garden, so wild it’s like the whole world is green and spilling over everything, advancing in a wave. He buries his focus somewhere out there.
Ange gives him another squeeze.
‘Mum would’ve said the same,’ she says.
He doesn’t reply.

going home

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The old, shadowy, three storey Victorian townhouse is the last one left in the line to be re-developed. Whereas the neighbours either side are smartly painted and appointed, have patios, architectural plants, chimeneas, vine-hung arbors, off-road parking, the old house staggers on with the archaeological scars of the last 150 years: a dilapidated gate you go round and not through; a rusting iron bench, a chunk of obsidian beside an unmade path, a horseshoe nailed to a yew tree. The whole thing has a blasted, portentous feel, like someone built a family home on the hill at Golgotha – and then realised what they’d done, and walked away.

‘Margaret’s coming home to die,’ says Philip. ‘She’ll be here in a minute.’

Philip is an old family friend. He’s known Margaret all his life – when she was a retired music teacher and he was a child student, come to learn the piano, reluctantly climbing the dusty slope to the front door, little knowing he’d still be doing it fifty years later.
‘She’s amazing for her age,’ he says, putting the finishing touches to the room. ‘The only pills she takes are Senna. And you have to crush those up in secret.’

Philip shows me into the room she lives in now – the only occupied room in the entire house. It’s been set up as a micro-environment: bed, zimmer frame, commode, armchair for sitting out in, health permitting, to stare out of the window at the busy road below and beyond, the vast bright spread of the city.

It’s a poignant experience, standing in this room. The piano she last played a dozen years ago when she was ninety is now an extempore stand for photos and wet wipes and sanitary products. Around it, quietly disappearing into the muted walls, a selection of photographs of ancient vintage, sepia family groups, Edwardians in suits and bowler hats lounging awkwardly on the grass; fading figures in boats or on horses; matriarchs in severe black dresses promenading along a sea wall, fishing boats with sails in the bay; men in huge moustaches and braided uniforms; a woman in a tweed suit and upswept, tortoiseshell glasses, smiling up at the camera, a pen in her hand.

We hear the ambulance crew struggling up the path, so we go out to help them.
They carry her into the house on their portable chair, a decrepit royal on a bier.
‘Where d’you want her?’ says one of them, sweating.

* * *

Later, when Margaret’s settled and we’ve brought in all her things, the same ambulance man kneels down in front of her and holds her hand.
‘We’re going to go now,’ he says, loudly and slowly, ‘but we’ll leave you in the care of these good people.’
‘Let me tell you something,’ says Margaret, pulling him towards her. ‘You have a very rare gift – the ability to give people complete confidence, and to put them at their ease.’
‘Well – that’s very kind of you,’ he says, blushing. ‘Thank you very much. No-one’s ever said anything like that to me before.’
‘That’s a shame!’ says Margaret, patting his hand and releasing it. ‘Everyone needs a little encouragement, don’t you think?’ She looks around the room, sees me, and leans back.
‘Now. What in the devil’s name is THIS?’ she says.

tangled up in brown

~ jim clayton ~ 2 Comments

I let myself in with the key from the keysafe.
‘Hello? Jack? It’s Jim, from the hospital…’
The bungalow is profoundly quiet, a heaviness to the air, cloying top notes of sweat and something else, the noxious atmosphere accentuated by the solitary drilling of a fly. Curtains drawn, a soupy brown half-light through drawn curtains. A door at the far end of the hallway standing open.
‘Hello…?’
Into the bedroom. The single bed on my immediate left rumpled up, nothing on it but a soiled bottom sheet, rucked up with a bias to the left; the contents of the side cupboard spilled or spilling; a chaotic pattern of smeared brown stains on the white wardrobe doors and across the floor – and then Jack, naked, lying on his back on the floor beside the bed, a lit desk lamp clutched to his chest, the cord tangled around his arms and legs. At first I think he’s dead, but then I notice a trembling in his abdomen, intermittent breaths, and when I touch him on the shoulder nearest to me, he shudders, opens his eyes and stares straight up at the ceiling, smiling in a beatific way, as if the touch was the answer to a long vigil of prayer.

I call for an ambulance once I know he’s breathing and stable. Even though they say they’ll do their best to get here quickly, and despite his poor condition and the likelihood of a long lie, he’s still only a medium priority and there’s a chance the ambulance may get diverted to something else. In the meantime I set about trying to assess Jack more thoroughly, and make him more comfortable. I put blue overshoes on, a plastic apron, gloves, and set to work. I turn off the lamp and gently disentangle him from the lead. After a quick top-to-toe that seems to exclude any obvious fractures, I use whatever pillows and bedding I can find to put under and around him to ease his position. I run a quick set of obs. I’m just about to go into the kitchen to find a beaker for water when Jack’s son Joe arrives. Joe is shocked by his father’s condition, but he manages to contain it for the future in the cause of setting things right in the present.
‘He was fine when I put him to bed at half seven last night,’ he says, putting on the overshoes and gloves that I give him, then helping me shift the furniture around to make room for the ambulance crew. ‘He’s had this UTI recently. The antibiotics haven’t been touching it. He was hallucinating about cats last night. He said the house was full of ‘em. I was going to talk to the doctor today to see what the plan was.’
He looks down at his father, and shakes his head.
‘Why didn’t you press your button, dad?’
Jack opens his eyes again and makes some incomprehensible sound.
‘He’s pretty dehydrated. I was going to give him some water,’ I say. ‘It’ll have to be in a beaker, though. His blood pressure’s quite low and I’m wary of sitting him up too much.’
‘I’ll see if he’s got one somewhere,’ says Joe, and pads off into the kitchen to find one.
Meanwhile I fill a basin with soapy water, get some dry wipes out of my bag and start cleaning Jack up. He’s in a terrible state. I’m guessing he must have had several episodes of diarrhoea through the night, the smear marks on the floor and wardrobe where he scrabbled around ineffectively. His hands are caked, his long nails thickly rimed, his body filthy – even the lamp is covered in smeary hand prints where he’s hugged it over night – for warmth, or light, it’s impossible to say.
I start work on his face and hands.
The ambulance arrives.
A paramedic walks into the room, clutching a clipboard.
‘Oh my good God!’ he says. And then, looking at my apron and overshoes, adds: ‘I don’t suppose you’ve got any more of those, have you…?’

getting to be good

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If you stepped out of the general press of the pavement traffic for a moment, stopped and really looked at the street – maybe somewhere out of the way, in the shade of this plane tree – you might see how things have gone along here, how the street was developed over the years. Some old fisherman’s cottages further down, tucked away from view now; two rows of Georgian townhouses, mirror opposites on either side; three Gothic red-bricked houses with dragon finials and black and white floor tiles, and then a lumping sequence of tall, rectangular blocks – art deco, modernist, brutalist. Accompanied by a jerky, stop-start animation of men in straw hats, flat caps, baseball caps; women in bonnets, beehives, sunglasses; horses and buggies, bread vans on bicycle wheels, cars with fins, electric cars…

John and Velma live in the basement of one of the red-bricked houses. It’s strange to think that when the houses were built in the mid-nineteenth century, all the bricks would have been delivered by horse and cart. Now it’s just me walking up the driveway, dragging a pull-along suitcase of equipment, a bag over my shoulder, an ID badge swinging from my belt.

Waiting at the back door for an answer, I can see the house has fallen on hard times. The Victorian bell-pull has been painted over so often it looks like it’s been moulded out of fondant icing, and a handful of other vintage buzzers exist only as empty bakelite brackets or waterlogged plastic shells hanging by the wire. The only buzzer that looks remotely patent doesn’t light up when I press it, so I face that familiar dilemma: Do I ring again, more positively, in case it hadn’t worked before? Do I wait longer, knowing that John has mobility problems (and guessing Velma has gone out)? Do I phone again – knowing full-well that if John is halfway to the door, he’ll only turn around and slowly go back to answer it? Because it’s been a little while now. I’ve looked around some – seen the buddleia and hart’s tongue ferns sprouting out of the brickwork; seen the sun-bleached Father Christmas grinning helplessly amongst the denuded forks of the dead Christmas tree in the pot; wondered about the sequence of events of breakages and repairs to the stained-glass panes of the door.
I ring the bell again.
Five minutes later I give in and phone.
‘Yes?’ says John, immediately, as if he’s been waiting there all along.
‘Hi John. It’s Jim – from the hospital. I’ve rung the bell but I wasn’t sure if it’s working or not.’
‘Yes, I’m coming,’ he says. ‘Sorry. I’m a little slow.’
An age later there’s a glimmer of movement through the miss-match of panes, a shuffling sound, the ghostly image of a hand reaching forwards, the door gives a shudder and swings open.
‘Hello John!’ I say, gently pushing it wider. ‘It’s Jim, from the hospital.’
‘Yes, you said,’ he says, a broad smile behind an enormous beard every bit as Christmassy as the figure in the plant pot. ‘Please come in. Sorry I was slow, but…’ He shrugs. I’ve read the notes. John has cerebellar ataxia. Any kind of getting around is a struggle.

* * *

Velma is busy in the kitchen as I finish off the visit. She’s as thin and active as John is heavy and slow. It’s like the balance of their relationship has tipped physically as well as emotionally, Velma radiating energy, John turning inwards.
‘I like my consultant, though,’ says John, widening his arms and hands, as if the consultant were a hologram he was conjuring in his lap. ‘When I asked him what causes this, he said in my case he just doesn’t know.’
‘I suppose it’s better to be as clear as you can about these things.’
‘Absolutely. I want the truth. What else is there?’
We chat about the things our service can do to help, the physio and occupational therapy.
Velma hurries through with a trug of washing on her hip to hang outside in the garden.
There’s a knock on the door – which I think Velma must have left open when she got back – because there’s a Hello? Delivery? and seconds later a hesitant guy in a yellow vest pops his head round the door and waves a clipboard. He looks at me for a response, but before I can say anything Velma rushes back in.
‘Let me show you,’ she says. They both go down the corridor, into the kitchen.

* * *

On my way out, I look in on Velma to say goodbye. She’s standing surrounded by swathes of clear plastic wrap, cardboard panels, polystyrene blocks. Towering over her is a new fridge-freezer. I can’t imagine how she’s going to cope with finding space, let alone moving it.
‘Do you want a hand…?’ I say – with some hesitation, I have to admit. I’ve got other patients to see; this’ll take some time.
‘No, thank you,’ says Velma, wiping her forehead with the back of her hand. ‘I’m getting  good at this.’

mandy’s eyrie

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Mandy’s flat is at the top of the block – so much so that the lift doesn’t extend there, and we have to walk the last two flights. It makes me think of an osprey’s nest, a junky bundle of sticks wedged in the uppermost branches of a pine. The nest is made up of old music magazines, Janice Joplin posters, empty cans, unpaid bills, unopened nutritional milkshakes, and the osprey itself is a haggard, featherless old bird, smoking a roll-up, staring unblinking over the city.

‘I’m a singer’ Mandy says, her voice so broken she can hardly talk. ‘Or was. ‘scuse the mess.’

She offers us a seat – a dirt-shined cushion in a sixties wicker chair, and a spot at the end of the crapped-up sofa. Standing isn’t an option, but at least this is the last job of the day.
‘Thanks’ I say, and we both – slowly – sit down.

I hardly know where to start. We’d come to see Mandy as a double-up as the notes on her file described how she’d been hearing evil voices telling her to tear herself and other people up.
‘But don’t worry. A and E did a risk assessment,’ said the co-ordinator. ‘No history of violence, and they don’t think this was a psychotic episode, as such.’
‘As such?’
‘No. More to do with alcohol withdrawal. So doubling up should cover it.’

I’ve never really understood the doubling-up rule. The way I see it, it doesn’t matter how many people you send in, someone’s going to get hurt. If anything, having other people with you only acts as a distraction. Although it does make me think of that joke about the two rangers walking in the forest, talking about the danger from grizzly bears. ‘Because they run pretty fast, you know.’ ‘Yeah?’ says the other. ‘Well I don’t have to run faster than a grizzly bear, Chuck. I just have to run faster than you.’
But I suppose it means there’ll be a witness

The other thing frustrating thing about this particular call is that Mandy goes out. A lot, according to reports. She gets drunk, then spends her time wandering the corridors of the block shouting and causing trouble. There’s an on-going spat with an ex-boyfriend who has recently moved in with another woman on fourteenth. And any number of substance abusers scattered through the block mixing things up – socially as well as chemically. All in all it sounds like a recipe for chaos, and not something that’s going to lend itself to regular, well-apportioned community care. At a time of severe underfunding, it seems crazy to throw resources at a patient who has the capacity to decide whether they drink or eat or take drugs or not. It’s a lifestyle choice – however severe that choice works itself out in practice.

But our community health team doesn’t have the latitude or leverage to protest. The referrals come in, we go out.

The brief is to establish regular contact with Mandy. To get carers going in every day to encourage her to eat and get her used to some regularity in her life.
‘It’s only until a more regular provider can pick up’ says the Co-ordinator.

‘I’m sorry I wasn’t in earlier,’ say Mandy. ‘I had to go to the doctor’s.’
‘Oh? How did you get there?’
‘Taxi,’ she says. ‘Well they’re not going to come here, are they?’

a tough gig

~ jim clayton ~ Leave a comment

Turns out, Miriam’s down to Assist the Co-ordinator this morning. She waves me over as I pass through the office, scattering good mornings as methodically and benignly as an Amish farmer sowing corn.
‘They’ve put me down to do an early care call as well,’ she says, looking flushed. ‘I mean – I’m good, but I’m not that good. I can’t be in two places at once! Everyone else is full, so it looks like only me or you that can do it. I’m more than happy to go if you want to hold the fort here a couple of hours… just as happy if you want to take the job… totally up to you. What do you think?’

The truth? I don’t need to think, but I make a polite show of it. Assisting the Co-ordinator sounds easy enough but it’s actually a pretty tough gig. It doesn’t matter how resolved you are at the start to be organised and Zen Master about the whole thing, barely half an hour later you’ll find yourself with a mobile clamped to one ear, a landline playing loud psycho-electro on-hold music in the other, three people hovering close by, checking their watches, stress-paddling foot to foot, someone else waving a piece of paper over in the Hub…. and then you’ll sigh, and hang up the landline, take a swig of coffee instead, and find it’s grown a skin.
‘It’s okay. I’ll do it,’ I tell her.
‘Are you sure?’ Miriam says, a desperate look in her eye.
‘Don’t worry. Happy to help.’
I take the details.

It sounds straightforward. Charles is an elderly patient who’s going into respite for a few weeks to give his wife June a break. He needs a care call first thing to help him get ready for collection by ambulance. As soon as I’ve picked up my other jobs for the morning, I ring their number. It goes to voicemail. I leave a message to apologise for the early call, and to say not to worry because I’m on my way and I’ll be there by half past eight at the latest.

It’s a bright, zesty drive out to their address, a neat red-bricked block on the outskirts of town. There’s a truck parked outside. Three workmen are busy putting scaffolding up, making a stunning amount of noise – pneumatic drills, banging, shouting, laughing, a radio on full volume in the cab. The workman at the top of the scaffolding, hanging on by one hand, actually throws back his head and howls. It’s all so loud and violent, even though I press my ear to the intercom I can’t hear what June says. The door clicks regardless. I go in.

The thickly carpeted hallway is so quiet by comparison with the racket outside my ears actually whine. I walk up three flights of stairs, then knock. After a long pause, June opens it. She’s tiny, frail as an old sparrow in a housecoat and slippers, blinking at me with her head slightly to one side whilst still holding on to the door.
‘Can I help you?’ she says.
‘Oh!’ I say. ‘Good morning. I hope I’ve got the right address. I’m Jim, from the Rapid Response team. I’ve come to see Charles.’
‘Charles?’
She stiffens even more, glances down at my ID badge.
‘To get him ready,’ I say.
‘What do you mean? Get him ready? What for? Who are you again?’
‘Jim. I’m a nursing assistant. From the Rapid Response.’
‘I’m sorry but I think there’s been some mistake.’
‘They asked me to come and help Charles get dressed. Before the ambulance arrives.’
‘I don’t think the ambulance will be coming,’ she says.
‘No?’
‘No. I wouldn’t think so. I’m sorry, but I think you’ve had a wasted journey. Did the nurses not tell you?’
‘What nurses?’
‘The nurses who were with us all last night. When Charles died.’
‘I’m so sorry.’
She stares at me, blinking rapidly.
‘Yes. Well,’ she says.
‘And – how are you – bearing up?’ I say, pathetically.
‘It’s early yet,’ she says. ‘But I’ll be fine. I’m sorry you came all this way.’
‘No, no! I’m sorry to turn up like this. That’s awful. I’ll make sure everyone else knows.’
‘Could you?’ she says. ‘That would be kind. Well – goodbye, then.’
And she quietly closes the door.

Outside the workmen are as furious as before. The one who was howling at the top on my way in is now leaning right out, shouting for a particular clamp.
‘Not the three four, you wingnut! The five n’alf! Ye-es! That one, Rodney! That one! Jesus Christ!’
It gets chucked up to him, and he catches it just as it slows, ready to fall back to earth.
‘Halle-fucken-lujah!’ he says, then swinging round again, gets back to his hammering.

ol’ blue eyes & the bug

~ jim clayton ~ Leave a comment

‘That’s got to be one of the worst discharges I’ve ever had the displeasure of seeing. I mean – for heaven’s sake! It was tantamount to fly-tipping!’
Rosie is smiling like she always does – an easy, enfolding, wise-woman kind of smile that’s been tested for years in the community and is all the warmer for it – but I can tell even Rosie is shocked.
‘I mean – poor thing’s end stage COPD. Thin as a rake. Can’t stand on her own – certainly not safely. I wouldn’t send her home with a live-in carer, but she’s still only got people going in twice a day. When I went in she wasn’t wearing her nasal specs, so her SATS were non-existent. She was in a right state.’
‘So what did you do?’
‘I sent her straight back in! I know they’re short of beds, but that was ridiculous.’

It’s early evening. The rapid response office is cooler and calmer. The change from the morning is astonishing. Then, every desk space was occupied, the kitchen crowded with people making drinks, people walking backwards and forwards, stopping for urgent briefings, catching-up, gossiping, serious conversations, hilarious conversations, secretive conversations, the whole thing layering and building and rising with the press of the day’s business until it reaches a peak and all you hear is a great massy buzz, the murmuration of a large community health team getting ready to fly out over the city. Now, at the end of the day, the last of us are coming back, handing over, doing admin. It’s quiet. There’s plenty of space. I love it.

‘And that’s not all,’ says Rosie, sitting on the edge of the desk and reaching into her pocket. ‘I brought back a friend…’
She pulls out a clear plastic specimen tube, about as big as your thumb, with a screw-top lid. She holds it in front of her and gives it a little shake. Inside is a bed bug. It’s on its back wiggling its legs in the air, but she taps the tube helpfully, it rights itself, and begins pacing up and down the tube, exploring the confines of its prison.
‘The place was riddled,’ she says. ‘They were supposed to have fumigated it but it obviously didn’t work. You’d think they’d have checked. These things are indestructible.’
She waggles the tube again; the bed bug tenses.
‘I heard they’re a really ancient life form. They were being a pain when the dinosaurs were around. Although they probably weren’t called bed bugs then.’
‘No? Probably Tyrannosaurus Rex bugs.’
‘Bronto bugs.’
‘Jurassic pain in the arse bugs.’

One of the admin workers at the far end of the office has the radio on quietly, which is always a nice touch this time of day. It starts to play the famous intro to that Frank Sinatra song, New York, New York.
Rosie gives the tube another shake and holds it up to her face to have a close look.
‘They’re quite cute, in a horrible kind of way,’ she says. ‘I suppose we’ve all got our roles in life. You have to respect that.’
‘What are you going to do with it?’
‘Oh – I thought I’d probably put him down the toilet. Burial at sea. Poor thing. I’ve got enough pets, though.’
She smiles, and starts singing along with Frank.
‘I’ll make a brand new start of it, New Yoooork, New Yoooork…’
She slips the tube back in her pocket and jumps off the desk.
‘But that’s the way of the world, I guess. Somebody singing New York, New York; somebody getting flushed.’