sketches

sad eyed lurcher of the lowlands

~ jim clayton ~ Leave a comment

It was the dog that brought it back.

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

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

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

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

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

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

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

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

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

where you sleep

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

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

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

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

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

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

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

buy one get one free

~ jim clayton ~ 2 Comments

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

It felt good to get out.

* * *

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

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

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

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

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

bonnets vs aliens

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

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

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

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

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

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

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

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

* * *

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

* * *

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

making faces at the fishes

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

sea storm

~ jim clayton ~ 2 Comments

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

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

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

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

smoko

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

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

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

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

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

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

‘All right?’ she says.

the longest hour

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Joan is lying in bed, a beanie wrap-around cushion supporting her neck, her long white hair wild on her shoulders.
‘I’m quite alright as I am, thank you,’ she says fussing ineffectually at the sheets. ‘I don’t want anything.’

Joan is ninety-five, tiny, translucent, tethered to the world by her watch and her will and the pictures on the wall.

‘I had a twin brother,’ she says, not to me, I don’t think, particularly, or anyone else in the room I can see. ‘Flew with the RAF. Never came back.’
‘Sorry to hear that.’
She doesn’t react.

I’ve come to see how Joan is after her fall yesterday. The ambulance picked her up, although a mouse could’ve done it. I can’t imagine Joan falling – or at least, only as a dried leaf might fall, slowly, with a soundless settling to the forest floor.

‘I was an hour older,’ she says, closing her eyes, to bring it clearer to mind. Then adds: ‘It’s a little more than that now.’

behind the glass

~ jim clayton ~ 2 Comments

The almshouse cottages are laid out on three sides of an immaculately kept croquet lawn. The white enamel paint is a little chipped on the hoops, showing patches of dark iron underneath. Maybe that’s through being struck with croquet balls over the years, but I’ve never actually seen anyone play. In fact the most life I’ve ever seen on the green is that crow, hopping around in the misty rain like a sexton in a frock coat, his hands under his tails, inspecting the lawn for worms.

Helen won’t be out playing croquet anytime soon, rain or shine. It’s enough of an adventure just making it from the armchair to the bathroom and back. I can imagine she would have been good at it though, sometime before the war, bobbing down to line up the final shot, giving the ball a hearty thwack, snatching off her cap, throwing it in the air, and then jogging over to the judging desk, the croquet mallet balanced on her shoulder. But of course, she wouldn’t have been living in an almshouse then. She would have been in nursing accommodation in London, excitedly practicing the air raid drill, hurrying out to dances, learning her craft.

Seventy years or more have passed since then, and Helen’s world has contracted to the size of a single room. It was small to begin with, but in an effort to stop her from falling the bed has been brought into the living room, leaving just enough room for a commode, a zimmer frame, an armchair and a side table. She still has her shelves of books, of course – one case devoted to Miss Read, whose name is repeated with dizzying regularity up and down the spines – but if you wanted to fetch one out you’d have to move a stack of things first.

Helen has been sitting this whole time with her head resting on the open palm of her right hand. She straightens now and again to look between her daughter Karen and me with an anguished look on her face.
‘I simply don’t understand what it is I have to do,’ she says.
‘You don’t have to do anything, mum. We’re just talking about things we can do to help you get better.’
‘Is it money? I think I have enough. But if you need more I can get another job.’
‘No, mummy. Don’t fret. We’ve got enough money. You’re job is to rest and focus on getting better.’
‘But all these people,’ says Helen, frowning at me. ‘I don’t know who they are or what they want. What do they want, Karen?’
‘They want what’s best for you, mummy. Like we all do. Try not to worry.’
‘But I do worry! I can’t stop worrying!’
Karen goes over to give her mum a hug, but Helen irritably pushes her away and then slumps forward again.

It’s an impossible position for Karen. Not only does she have the grindingly practical business of caring for an elderly mother whilst running a family of her own, she has to do it without the one person she’d naturally have turned to for advice and support, as she did all through her childhood, adolescence and beyond, the single parent who’d trained and worked as a nurse, the woman who’d seen things and suffered things and come out the other side with her hands and her uniform clean, who’d always somehow managed to be just as strong and as resourceful as she needed to be, the woman that was somehow in the room and yet out of it at the same time, as remote as that black and white photograph of a newly qualified nurse in a pristine uniform, sitting with a straight back behind the glass.

‘Anything you could do to help would be great,’ says Karen, smiling weakly at me. Then reaches over to squeeze her mum’s shoulder.

polaroids of pets and their owners

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1.
Geoffrey has two cats. Suki is a heavyweight, silver grey affair, sprawled on the seat of Geoffrey’s four wheeled walker like a luxuriously furred but rather bedraggled cushion, one paw draped over the side, an expression on her face of the purest hatred for the world and everything in it, especially Harry, the kitten. Harry is as hyperactive as Suki is inert, seemingly on a mission to destroy the bungalow, in such random bursts of activity it’s like watching a film that slows one minute and speeds up the next. Harry attacks the curtains, my bag, a pile of rubbish, the TV cables, winding himself up for each assault with a tensioning wiggle of his hips, whipping his tail from side to side, then skittering across the carpet – this time to take out a little stuffed dinosaur, rolling over and over with it, coming to a stop on his back with the dinosaur in its teeth and front paws, brutally pedalling it to death.

‘He’s having a funny five minutes,’ chuckles Geoffrey from his riser-recliner throne, King of Catland, packets of fishy favours to hand on the cantilever table.

But I’ve already been here ten.

2.
‘Are you okay with dogs?’
It’s an article of faith to say yes, because Leila’s brindle staffie Frankie is hurling himself against the baby gate so violently you’d think he hadn’t eaten in a week and a leg of mutton just walked in the door. Before I can answer either way, Leila unlatches the gate and Frankie bursts out. I stand my ground and ignore him – and, thank god, it works. In fact, it’s extraordinary how quickly he changes mode: from Hound of Hell to Snuffly Chump.
I scraggle him behind the ears, and he seems to like that. Then suddenly he’s reminded of something, and hurries off into the sitting room.
‘Oh no,’ says Leila. ‘Wait for it.’
There’s a plaintive squeak or two, then Frankie comes trotting back into the hallway to sit at my feet with a blue ball clamped in his jaws.
‘Oh for God’s sake,’ says Leila. ‘Him and that ball. I wish I’d never got it.’
Frankie bites down on it twice in quick succession, to emphasise.
‘It was funny the other night, though,’ says Leila. ‘He fell asleep with it in his mouth. Then he started dreaming, doing that spooky eye-rolling thing they do, twitching and jerking, and then the ball squeaked, and woke him up, and scared the bejeesus out of him. He fell off the sofa and the ball squeaked some more and he dropped it and ran behind the curtains. I thought that might’ve cured him. But no, he was straight back on it. Poor ol’ Frankie. He’s like me – an addictive personality.’