Glenda’s smile is so utilitarian I imagine she keeps it on a hook by the door.
‘Thank you so much for coming,’ she says – then waits in the hall for me to enter.
‘Shall I take my shoes off?’
‘Not many of your colleagues do.’
‘It’s what I do at home,’ I say. ‘It feels weird otherwise’
She watches as I slip them off and line them up with the others.
‘Easy on, easy off!’ I say, although the faux-Cockney falls flat.
Glenda watches me, one hand hooked over the other, a self-conscious and mechanical kind of coupling, like a robot that hasn’t had the soft skills upgrade.
‘What people don’t realise is the toxins they’re tracking through the house if they don’t take them off,’ she says.
‘No. Exactly. And anyway – I like the feel of a wooden floor under my socks. So…’
I wait for her to lead me through to her mother, the patient I’ve come to see, but Glenda stands absolutely still.
‘Take tarmac, for instance. They seal it with a cocktail of chemicals that are severely detrimental to one’s health. The sun comes out, the sealant becomes tacky, it adheres to the underside of the shoe, and you walk it in. Tests have shown the average household dust carries concentrations of harmful toxins such as PAH, which is implicated in respiratory and other illnesses.’
‘I bet.’
‘And then there are the bacteria, of course. E coli. C. diff. Klebsiella’
‘Yes.’
‘Not to mention all the debris and dirt you’d expect to find in the street and the garden.’
‘So – are you a microbiologist or something?’
She flinches.
‘No! I’m a lawyer’
‘Oh.’
I shoulder my bag in a resolute way that’s supposed to indicate I’m ready to move on.
‘You do understand the situation here,’ she says, after a significant pause.
‘Well – I think I do. The basics.’
‘Perhaps I’d better explain,’ she says. I adjust the weight of the bag on my shoulder.
‘My mother is ninety years old, a fully independent person who lives without assistance in a small village in Somerset called Duckton. She was on a visit to us when she became ill with a urinary tract infection, and suffered a minor injury fall, and was taken to hospital, where she spent three days. The hospital deemed her to be medically ready for discharge, on the understanding was that she should have one month of community rehabilitation, with therapy and nursing support, and care three times a day. Which is where you come in.’
‘Okay.’
‘There have been a number of medication changes effected at the hospital, and these have all been ratified by my own GP, who has taken temporary care of my mother whilst she is away from home.’
‘Great.’
‘Now. What I need from you – other than a medical review this morning – is to provide a report detailing all therapeutic programmes undertaken by your department, nursing interventions and so on, and for these to be communicated to my mother’s health authority in Somerset. I want assurances that all possible measures will be taken to maintain her safety when she returns home, provision of all necessary equipments and so on, and continuing care support from agencies in that county. Is that something you can help us with?’
Glenda talks in such a relentlessly steady way that it’s something of a lurch when she stops, like coming down a long flight of stairs and unexpectedly putting your foot down flat.
‘Well…erm… that’s not usually how it works.’
‘Explain to me how it usually works.’
I blush, and cast around for a friendly face. All I can find is a vast, frowning, butterscotch cat staring at me from the cushion of a Windsor chair. It looks so severe I wouldn’t be surprised to see it reach up and place a square of black cotton between its ears.
‘The thing is – Glenda,‘ I say, swallowing drily. ‘We’re an acute team. We get referrals from the doctor, the ambulance or the hospital, and we go in, and we make sure everything’s okay. Nursing, therapy, care or what have you. And when we’re done we refer back to the GP. Or make other referrals for chronic, longer-term needs, to the district nurses and others. And that’s about it.’
She sighs, once, heavily, as if she’d asked for architectural plans and been given sugar paper with a crayon sketch of a house.
‘It’s a question of resources,’ I say, helplessly. ‘A real world thing. We struggle to look after the people who live here, let alone the other side of the country.’
‘As I explained to you,’ she says at last. ‘I’m a lawyer. Now. A piece of paper with a signature on it constitutes a contract. And your service has contracted to provide us with one month of therapeutic, nursing and auxiliary care needs, prior to repatriation.’
‘Has it?’
‘Are you telling me this is not actually the case?’
I pick my bag up.
‘Glenda,’ I say.
She gives a small nod of her head, activating another, thinner smile.
‘I’ve come here this morning to see your mother. To see how she is, do her blood pressure and so on. I have an awful lot of other patients to see today, so I haven’t really got time to talk about the finer points of these things, much as I’d like to. So do you mind if we…?’
The smile flicks off again.
‘For example. If I was buying a boat,’ she says.
‘A boat?’
‘Yes. A boat. There are certain rules pertaining to the transaction that would need to be adhered to in order for that transaction to be properly concluded, to be watertight.’
An anguished voice calls out from the front room.
‘Who’s that at the door, Glenda? Is it the nurse?’
‘Coming!’ I say, shrugging, and holding up my hands. ‘Just losing the shoes…’
sketches
waving, and calling
The outside of the building has kept its elegant facade, and the cool black and white tiles of the hallway, the low-hanging chandelier and the multicoloured blaze of the leaded light window are about as perfect as you’d want for a Regency costume drama – so long as you were careful to keep the burnished steel lift out of shot.
The voice on the intercom was pretty direct.
Come inside, get in the lift, don’t touch the buttons.
I do as I’m told, and wait.
Nothing happens.
Did I hear her right? I can’t understand why I shouldn’t press anything. Maybe she thinks I’ll be confused by the mezzanine floors? Maybe when the place was converted into flats there was some architectural kink, and people are always getting lost. I can’t believe it, though. It all seems straightforward.
I wait some more – for what, I’m not sure.
Eventually the lift shudders and I start moving up.
Mrs Rouncewell is there to meet me.
‘Hello!’ I say, slipping off my shoes and then immediately wondering where to leave them.
‘Oh – you don’t have to do that,’ she says, obviously relieved that I have. I put them down as neatly as I can side-by-side beneath the enormous, floor to ceiling artwork that dominates the hallway. We both look at them a moment, in the confused and slightly disappointed way two people visiting an art gallery might look at something they’re not sure is an exhibit or littering.
‘So… what’s with the buttons?’ I say at last, as she leads me through to the lounge.
Mrs Rouncewell gives me a measured smile that I take to mean she’s explained this a few times before.
‘The lift opens directly out into the flat. You have to use a code to make it work, but that’s too difficult to explain over the intercom, so it’s easier just to say don’t touch the buttons.’
‘That explains it!’
‘It’s a security issue.’
‘Unusual.’
‘Unusual? In what way?’
‘Having a lift that opens directly into a flat. I’d never thought about that before.’
‘Yes. Well.’
She waits to see if there’s anything else, then leads me up a short staircase into a gigantic room that must be the footprint of the house, the furthest wall replaced by a panoramic plate glass window, a section of which stands open, revealing an immaculate rooftop garden, bistro table and chairs, and beyond the filigree railings at the edge, a wide city vista of houses and office blocks, all on a shining blue sky.
Her mother is lying in a riser-recliner chair, a halo of fine white hair ruffled by the breeze from the window. She looks comfortable, but her dementia has left her with a flushed and approximate look. She orientates herself to the change in the room like a newly-hatched chick.
‘Hello’ I say, putting my bag and folder down and offering my hand for her to shake. ‘Lovely to meet you.’
She reaches up and takes my hand – then suddenly cups it with both of hers, so strongly it’s quite a shock, and keeps it there, like she’s scared if I let go she’ll rise up and float off through the window, and see the two of us, her daughter and me, hurrying out onto the patio, waving from the railings as she trails helplessly away across the rooftops.
Calling out, maybe.
Waving, and calling.
syracuse & the duck
Jennifer Syracuse is my name of the day – the year, probably. A private detective kind of name. The name you’d give to that character in the book who crashes in on page three, lights things up and drives all the way to the big reveal.
These days, what with one thing and another, the brandy bottles clinking in an unbroken line from sometime back in the fifties out to an empty bottle on a windowsill; the falling away of friends and family connections; the piling up of clutter until even the long-case clock strains to keep its face clear – these days, Jennifer Syracuse is lighting up the world a little less, and the big reveal has long since flattened out into something longer, looser and more predictable.
‘When you see a duck have its head cut off you know you’ll never eat pate again. The way the feet waggle – d’you know? They keep on waggling.’
She looks up at me from where she’s sprawled on the ottoman.
‘Do have a seat,’ she says. ‘You make the place look untidy.’
If you can ignore the heaps of clothes and books and undifferentiated clutter, it’s a pleasant enough flat. The french windows are standing open, and sunlight filters in through a thicket of wisteria, giving the place a sleepy, soupy feel. There’s a gigantic chocolate coloured cat on the only other seat clear enough to sit on, sprawled as luxuriously and definitively as Ms Syracuse.
‘That’s okay,’ I say. ‘I’m happy standing.’
‘I mean – how could anyone eat an animal?’ she says, ignoring me. ‘Take cows for instance. Now – don’t they remind you of the women’s institute? Fat old matriarchs marching around, jabbing you with their elbows. They’d look darling in a flowery hat, though, you have to admit. And then you get the young calves in the background, jumping up and down, wondering what all the fuss is about.’
‘I like cows,’ I say.
‘How could one not? I was brought up in India, for heaven’s sake! D’you know – the other morning I sat up in bed and found myself talking Hindi! I haven’t spoken a word in seventy years, and there I was, completely fluent! It passed, of course, but I’m convinced it’s in there somewhere. I just need to learn how to get it out.’
When I steer Jennifer towards the reason for the visit – her numerous falls, weight loss and general decline – she adopts a serious expression and struggles into a more upright position.
‘Would you keep your voice down! Please!’ she hisses, then leans forward and waggles her fingers for me to meet her halfway.
‘That bitch upstairs listens to every word,’ she says, then satisfied I’ve got the message, winks slowly in a lopsided way that threatens to extend into an extemporary sleep, comes to herself again, acknowledges me with a start, and taps the side of her nose.
‘What d’you want to know?’ she says, and collapses back on the ottoman.
a cussed old cat
‘You cat looks exactly like ours. That same splodge of white on his back, like someone threw a paint brush at him.’
The black and white cat slowly raises his head and orientates himself to my voice, his eyes tightly closed, as if he understands the insult – and would like me to see that he understands – but chooses not to respond, conserving his energy instead for the more important things in life, like sleeping. The moment passes; he gets back down to it.
‘He’s a funny old thing,’ whispers Derek. ‘A cussed creature. Does what he likes. Much like me.’
I’m glad about the cat. I mean – I like having animals around anyway, but in Derek’s case it’s a definite advantage. I’d been given plenty of cautionary notes about Derek beforehand. His new diagnosis of Parkinson’s disease, coming at a time of family problems generally. His self-discharge against advice. Self-neglect. Resistance to help. I’m calling round this morning ostensibly to dress a wound on his foot, but there’s more to it than that.
‘Of course, you are the boss of you,’ I’d said to him when he eventually answered the door. ‘You don’t have to do anything you don’t want to do. So long as you understand what it is you’re refusing, and what the consequences might be, you’re perfectly free to say no.’
It’s a speech I’ve used before, the verbal equivalent of putting the gun on the floor and backing up a little. It’s okay. I’m on your side.
‘Yes’ he said. ‘Well. Obviously.’
He talks softly and quickly through a fixed smile, his head tipped back and his eyes half-closed. Maybe it’s a combination of his illness and his natural character, but the effect is peculiarly unsettling, as if he’s using his very last reserves of sociability to maintain a pleasant appearance, like a light bulb connected to a failing generator, flickering on the edge of darkness.
I didn’t expect I’d make it over the threshold, but he’d shown me through to the sitting room, and that’s when I saw the cat.
‘He’s lovely’ I say.
‘There are foxes in the garden,’ whispers Derek. ‘They seem to get along.’
I ask him about his time in hospital while I bandage his foot.
‘Dreadful’ he says. ‘Jabbed and prodded all hours of the day and night. No explanations. No introductions. Bullies and fools the lot of them. I’d had enough. I walked out. Probably should have stayed. So long as they leave me alone. I don’t care.’
He smiles down at me.
‘How does it look?’ he says.
Derek’s wife Barbara comes in and although she seems perfectly pleasant the atmosphere changes. He shrinks a little into himself. She unpacks her shopping bags – sandwich packs, bags of crisps, milk, snacks. ‘Don’t mind me,’ she says.
‘We won’t,’ says Derek.
There’s a knock on the front door and Barbara goes to answer it.
‘Oh God’ says Derek.
Barbara shows someone in, a tall, brisk woman with an armful of files and folders and a blue NHS lanyard round her neck.
‘Oh! Hello there!’ she says to me.
‘I’m Jim from the community health team,’ I say, ‘come to dress Derek’s foot.’
‘Great!’ she says. ‘Excellent! Well – I’m Ruby, the social worker. Do you mind if I put my stuff on the counter?’ She unloads her files and things amongst the shopping, then turns to Derek, looming over him, supporting her weight with both hands on her knees, her ID card swinging in the space between them. She speaks slowly and loudly, for some reason.
‘Hello there, Derek. I’m Ruby. The Social Worker. Lovely to meet you.’
Derek leans away, his smile even more ghastly.
He draws back his foot.
‘Just let me get this last bit of tape on…’ I say.
‘We’re done,’ he says.
and so to bed
Community Health encompasses so much, from the acute to the chronic, the social to the medical, from the replacement of a single worn ferrule on a walking stick to the installation of a gantry hoist and a small army of carers; from a three day course of antibiotics to months of gruelling IV therapy. Work in it long enough and you’ll see countless variations, each situation particular to the individual patient and their family.
But if I was forced to nominate the one thing that caused the most problems out in the Community, I would say it was a Resistance to Change.
It’s been said before that the only constant in the world – the one thing you can be absolutely sure of – is that things change. And ultimately it’s not the specifics that matter so much as the way you embrace them. Hanging on to things that cannot possibly last, however much you’d like them to, inevitably leads to friction and unhappiness. A hard lesson to learn, of course, and one that needs constant practice and reinforcement, but no less important for all that.
Take Janice and Henry, for example.
Henry is a hundred. A simple expression of fact – impressive enough in itself, were it not for the fact that every night he goes up three flights of stairs to bed.
Janice goes up behind him, of course. Janice is Henry’s daughter. They’ve been living together a good many years, now, and they’ve got their routines. Latterly Janice has taken over the role of principal carer, a guy coming in every morning to help with washing and dressing. Janice is doing a great job in difficult circumstances, changing Henry’s pads, keeping him fed and entertained. They have a lovely relationship.
We’d been called in by paramedics, who attended a non-injury fall here the other day. Apparently Henry slipped out of his leather armchair downstairs, and Janice couldn’t get him up.
‘The footstool slid forward and he sort of jacknifed’ says Janice. ‘It was too early in the morning to do what I normally do, so I had to call 999.’
‘What do you normally do?’
‘I go out in the street and ask someone if they’d be so good as to come in and help.’
‘Isn’t that a bit risky?’
‘Oh no! People are good, you know. And I only ever ask the burly ones.’
‘Has Henry fallen a lot, then?’
‘Half a dozen times. Not falls so much as a gentle collapse. This one was different because he was in a funny position. Generally it happens on the stairs.’
‘The stairs?’
‘About half way. Occasionally his legs just give out. So he’ll sit on a step a while. And if he can’t get back up again, I’ll nip outside and fetch someone in.’
Janice has already given me a tour of the place. One of those rickety old town houses, compressed by its neighbours into a vertiginous, three-storey affair, two rooms per floor, Henry’s bedroom at the very top, the stairs leading up and up and up so relentlessly you don’t need a handrail so much as crampons and a bottle of oxygen.
‘I’m puffed and I’m half his age’ I said to her.
‘You shouldn’t be,’ she said.
We’d skated over the possibility of changing things around a bit. Maybe moving the bed downstairs. Janice was indignant.
‘Where would I sleep?’ she said.
‘I don’t know. Upstairs?’
‘Out of the question!’
‘He’d be safer.’
‘Yes – but… where on earth would I put everything?’
kung fu jack
‘Ya would’na think to look at me now but ah used to be a kung fu master’
‘Wow! That’s amazing!’
‘I were a lot younger then, mind. Fit as a sand flea. I hitchhiked everywhere. I’d put ma thumb out an’ jes’ see where it took me. One time it was Norway, man. Norway!’
‘I’d love to go to Norway.’
‘Yeah? Well ya should. It’s still there, far as I know.’
I finish taking the blood and writing up the notes. Jack folds his arms and watches me, one thin leg hooked over the other, the foot tapping gently up and down, the laces of the boot gently trailing in the air.
‘Ah’m not kiddin’ ya. A kung fu master. One thing we had to do, to qualify, like. We had to run down this dark tunnel, wi’ no light at all except what was comin’ in the end. An’ you had to run like stink towards it, and the only thing stoppin’ yah was everyone inside, punching and kicking the livin’ crap out of you. Now look at me. If you laughed too loud ah’d fall over.’
‘So where are you from originally? Are you a Geordie?’
‘A Geordie? Well there’s no need for that. I tell you wha’. It’s a good job for you ah’ve lost ma kung fu skills. Ah’m from Sunderland, man! A Mackem! Geordie. Ah’m thinking you must be one o’ them things from the south.’
‘I am. And d’you know what? I have to admit – to my shame – I’ve never been further north than the Lake District.’
‘What? Ya dowun nah what yah missing, man! We’ve got everything yah could want. Beautiful beaches, and … and … pubs carved out of the rock.’
‘Sounds amazing.’
‘It is amazing. The most unbelievable place on earth. An’ ah’ll tell you what. I’d go back there in a second if ah could jes’ snap me fingers an’ fly.’
a loss of balance
‘My psychiatrist is worried what effect all this is having on me,’ says Angela. For a moment I think she’s going to illustrate by pointing to her brain, but uses her finger to push her glasses back up her nose instead. She makes as if to fold her arms, then changes her mind at the last minute, puts them in her lap – and then changes her mind again, and folds them after all, leaning forwards with her shoulders hunched, rocking imperceptibly.
I’ve only been in the same room with Angela five minutes and I have to say, I’m as worried as the psychiatrist. Angela’s face is so intensely anxious, it’s as if someone had taken a cup, drawn round it with a crayon to get the circle, roughed in two permanently arched eyebrows, a pair of thick glasses, a flared nose, a downward pointing mouth, and then below it, as an afterthought, adding an incised groove like a second mouth, to amplify the sadness of the first.
‘You’ve got a lot on your plate,’ I say. ‘Anyone would be anxious.’
‘I am anxious,’ she says. ‘I’m very anxious.’
‘It’s understandable.’
Staring at us from the armchair opposite is the source of Angela’s anxiety: her father, William – an imposing figure, despite his extreme age. William is fastidiously dressed in a buttoned-up shirt and tie, bottle green cardigan, corduroy trousers with a sharp crease down the centre of each leg, his velcro-shoes box-fresh, correctly fastened. He’s so tall and gaunt, with so many edges and angles to him, you’d hardly think he was real at all. I imagine when he gets up at the end of the evening, he simply unfolds, flap by flap, like a complicated origami figure, cushion fold, chair fold, reverse-squash fold – and shuffles away to sleep in an envelope.
He must have some mass, though. He fell on the patio a week ago, taking his wife Rose with him, landing on her and fracturing her hip. Rose ended up in hospital, of course, with the prospect of a long convalescence. The only other sibling, Angela’s brother Tommy, works away from home a great deal and can’t spare the time. And as Angela is off on long-term sickness due to her anxiety, they decided – or at least, I would think, Tommy decided – that Angela should be the one who stays with William until Rose makes it home again.
‘I just can’t keep an eye on him every single hour of every single day,’ says Angela, hopelessly.
‘Hmm,’ I say. ‘What do you think, William?’
William slowly unlaces his fingers and then holds his hands apart in a sad, what-will-be-will-be kind of way.
‘It’s difficult,’ he says. ‘I don’t want to worry anyone. But it is unfortunately the case that – for whatever reason – I have something of an issue with balance.’
I turn to Angela again, who’s staring at me with such terror it’s like we’ve been dragged to the edge of a precipice.
‘You see?’ she says.
full volume
Rita is sitting in a high-backed chair watching a veterinary programme on television. A cow is so bloated the vet is driving a cannula big as a marlinspike into its abdomen; the farmer and his wife put their hands over their noses. ‘She’ll be a lot more comfortable now,’ the vet says. They nod, keeping their hands in place.
The television is on so loud Rita hasn’t heard us come in, so as gently as I can I say Good Morning and move into her line of sight.
She screams.
I’ve met Rita before, and I’d told Andreas what to expect. It’s a particularly terrifying scream, though, and he visibly reddens.
‘It’s okay! It’s okay!’ he says. ‘We’re from the hospital. We’ve just come to see how you are and what you might need.’
She screams again – exactly the kind of sound effect you’d want in a horror film if an elderly person was being murdered. Such an open-throated and desperate noise, made worse by the slack cavity of her mouth and the two, blockish teeth, offset top and bottom.
The odd thing is, she’s not screaming because we’ve scared her coming into the flat. She’s screaming because she wants us to do something. And sure enough, when I ask what it is, she points to the kitchen trolley.
‘The remote? You want me to pass you the remote?’
She screams again.
‘There you are, Rita! And please try very hard not to scream like that if you can, because it makes it difficult to understand what you’re after.’
‘Thank you,’ she says, in a normal voice, and stuffs the remote into the cushion beside her on the chair.
My colleague Andreas looks shaken, but I think he’s reassured I’m not freaking out. He adopts a similarly calm, super-moderate tone.
‘Now then, Rita,’ he says, squatting down and resting a hand on hers. ‘I’m the physiotherapist, and you’ve met Jim before, the nursing assistant. Is it okay if we ask you a few questions to find out how we can help you after your stay in hospital? Would that be alright?’
She fishes out the remote control with her free hand again and raps him on the knuckles with it – I guess because he’s in the way of her vet programme.
‘Oh! Sorry!’ he says, rubbing his hand and standing up again. ‘But Rita – would you mind if we turned the television down a little bit? So we wouldn’t have to shout?’
She screams again, and he almost falls over.
‘Now, now!’ I say. ‘Come on, Rita! Remember what we said about the screaming? Try to tell us as calmly as you can what it is you want.’
‘Soup!’ she says. ‘I want soup!’
‘Okay. That’s okay. I’ll make you some soup’ says Andreas, ‘but first let’s get the assessment out of the way, shall we?’
She turns off the TV and grumpily stuffs the remote into the chair cushion again.
Andreas has just turned his back to open his folders when she screams again, so loudly he almost dumps the lot on the floor.
‘What is it now?’ he says.
‘Clean these!’ she shouts, handing him two filthy magnifying lenses. ‘Clean them!’
‘Okay. I’ll rinse them under the tap for you, but then I really must get on with my paperwork. Okay?’
He takes the glasses, shakes his head at me, then goes into the kitchen.
‘Whilst Andreas is doing that, d’you mind if I take your blood pressure and so on?’
She grunts, staring at the television.
A rabbit is being sedated prior to an operation. The vet says he’ll take this opportunity to clip its nails, too.
I approach with my kit, gently wrapping a blood pressure cuff round her arm, and then putting the steth in my ear. Just behind her I notice a yellowing, photocopied picture taped to the wall – a Welsh terrier, sitting with its paws on a table. The dog is wearing pince-nez specs, a red spotted neckerchief and a knitted waistcoat. ‘He’s lovely’ I say, nodding at the picture. What’s his name?’
Rita screams.
It’s completely heart-stopping, like I’ve put the stethoscope into the mouth of a roaring lion. I snatch it clear and take a step back.
‘What?’ I say, shakily.
‘A girl!’ she says, in her normal voice. ‘She was a girl’.
Then she picks up the remote control, points it at the TV, and turns it up, full volume.
beatrix splutter
Agnes lives in the last of a series of two-roomed cottages that tail off into the privet at the far end of an obscure cul-de-sac. It’s a dead-end, deeply shaded, out-of-the-way kind of place. The kind of place you’d imagine outlaws to live – at least, a very suburban kind of outlaw, with mobility scooters instead of horses.
I pass a strange duo sitting outside the first bungalow: an elderly man and his equally elderly cat. The man has no teeth, which makes it look as if his flat cap is a plunger that’s been pressed and driven the upper half of his head further down into his neck. He’s liberally smacking his lips as he concentrates on rolling a fag, one long and skinny leg crooked over the other and spasmodically kicking up and down, no doubt in time to his heartbeat. The cat is sitting on its haunches on the rusted patio table beside him, so fixed on the fag-rolling it’s like he’s waiting for the old man to finish, and pass the cigarette to him.
‘Morning!’ I say as I walk past.
The old man nods and waves the half-finished fag in the air. The cat merely turns to stare, in one smooth, arrogant slide, and an expression that seems to say: Don’t distract him.
Agnes’s cottage is so stuffed full of junk there’s almost no room for Agnes. She’s installed in bed in a living room with just enough space to move from the end of the bed to the commode. The whole scene is like a burrow, poorly lit by a low-wattage lamp on the shelf above her that casts a febrile, enclosing kind of light. Agnes smiles at me as I introduce myself. She’s like a Beatrix Potter mouse in a bonnet and nightie, twitching her whiskers as Doctor Magpie hops in and starts flapping around, trying to figure out whether any of her problems are new or not, and what’s to be done.
An hour or so later, when I’m walking back along the path, and filling my lungs with fresh air, I can’t help wondering if I’ll see the old man and the cat again. And yes – they are there, in exactly the same position. The old man is still smoking, tipping back his head and releasing such a quantity of smoke you’d think each cigarette would be vapourised in one, deep drag. The cat has already heard me coming, and draws a bead as I walk past the gate.
‘Alright?’ I say, and then: ‘Nice day’
The man raises his cigarette in the air in the same way as before, except now he accidentally disturbs a quantity of ash into his lap. He curses, uncross his legs, leans forward, and begins urgently smacking his trousers clear. The cat watches him, then turns to look at me again, this time with an expression that seems to say: You made him do that.
a bottle of banana-flavoured drink
No-one knew why Alf was dying, but anyone could see that he was.
And as far as I could tell (it was difficult to ask), nobody knew why he’d refused any of the tests that might reveal the cause, chance of recovery, or time left. He’d been clear about that – certainly clear enough to reassure the medical team that he understood the consequences of his actions, and that his refusal wasn’t simply another manifestation of his illness. He may have explained his decision to them in detail. I expect he did. For us, the community health team, we simply had to accept that Alf had declined any further intervention, and wanted to be cared for at home. I can only guess why that was. Maybe he knew that anything they tried would be hopeless, and he’d lose his last weeks in a fog of operations, pain, nausea, medication. Maybe he was resolved simply to wade out with his eyes closed, and let the dark waters close over him. When I met him he was as passive as an anatomical doll, frail and uncommunicative, submitting to being rolled and cleaned from time to time, and not much else.
Alf’s deterioration had been so precipitous the family had started to gather in earnest, flying in from the extreme ends of the country, and abroad. The home they came back to was as unrecognisable as their father. Everything was in turmoil. There was a hospital bed in the front room, looking like it had been beamed up from a ward somewhere and crash-landed amongst all the fishing trophies and wedding portraits and domestic ephemera of a life. And it wasn’t just the bed. There was an abundance of medical supplies and pieces of equipment, the kinds of thing you need to treat an end of life patient at home, and beyond that, every available space was now given over to the cause, to temporary put-you-ups, and suitcases, and clothes hanging over balustrades, and then extemporary family huddles in the kitchen, or the garage, wherever they could gather together, and drink tea, and whisper severely, and let the old family rivalries play themselves out, as they ever will when families get back together for any reason, but most especially now, when one of their number is dying. They’d hurried across hundreds – even thousands of miles – and now they were here they found there was little they could do. Along with their horror of the situation they had to cope with boredom, and frustration, and being separated even temporarily from their own lives and problems, for an indefinite time. They relieved each other from their vigils at the bed. They did what they could to stay afloat. But the house was an anteroom of death, and the fact that no-one explicitly knew why made it worse for them.
Leah had been the first to come down. Leah had problems of her own. She was almost as skeletal as Alf, except in her case it was an eating disorder she’d struggled with for years. She tried to encourage her father to drink some of her own supply of fortifying milkshake, holding the straw to his lips and making softly encouraging noises.
‘He doesn’t want it,’ said her sister, Mae, her arms folded.
‘It’ll do him good. It’s designed to.’
‘Yes, but he doesn’t want it.’
Leah was wearing a strappy summer top that hung down from her, revealing the cruel extent of her illness. In fact, you’d have to say that there was only a degree or two of difference between Leah’s physique and her father’s, except – Leah was clearly on this side of the line, and he was on the other, and she was reaching over with her little bottle of banana-flavoured, fortifying drink, trying to do for him what she’d been trying to do for herself all this time.
‘He doesn’t want it’ said Mae.
‘But he might,’ said Leah. ‘Give him a chance.’
Mae was right, though. Alf’s eyes were already preternaturally large, made of some dull, inferior kind of glass, whilst Leah’s were still bright, and vital, and full of tears.
jim clayton 