sketches

maud’s mother

~ jim clayton ~ Leave a comment

It’s been three weeks since I last saw Maud. She’s the one hundred year old woman who spooked me a little by saying she was worried she couldn’t look after her parents who were asleep upstairs. I’m here this time with Stacy, a physiotherapist, to conduct a mobility assessment. The carers have reported a sudden and significant drop in Maud’s ability to stand. We need to figure out if this is a confidence issue or something more permanent.

Stacy is exactly the kind of person you’d want to have with you in a haunted house. She may be small, but she has big feet, a disproportionately loud voice, and a vigorous, open-faced, square-shouldered approach to things. I can imagine her standing in the middle of a dark room, the hectic shreds of wailing ghosts swirling round her, planting her bag on the floor and saying: Right! Firstly, no-one’s impressed. Secondly, what do you hope to achieve by this? Thirdly – just because you’ve been dead two hundred years, doesn’t mean you can fly around with the posture of a cashew nut. So straighten yourselves out, settle down, stop messing about and we’ll see what we can do to help. The ghosts would immediately clam up and hover in line. And Stacy would sort them out.

She could be a whole new kind of health visitor. A physioexortherapist.

Who ya gonna call?

Stacy listens carefully when I tell her about what happened last time, the whole ‘ghostly parents asleep upstairs waiting for their daughter’ deal, and also about what her next of kin, Alan, said about it, which was that in many religions it’d would be seen as quite normal to be ‘met’ as you neared the end of life.
‘Okay,’ she says. ‘Fine. But you do know that Maud spent many years looking after her parents? So I don’t think it’s all that surprising she’s a bit muddled with the timings. I hardly know what day of the week it is myself, and I’m supposed to be young and fit.’
‘No. I suppose when you put it like that.’
She re-shoulders her rucksack, reaches up, and knocks so firmly with the rapper on the door it makes me think of Jack from Jack and the Beanstalk, knocking on the door of the giant’s castle. But instead of a giant housekeeper coming to the door, it’s Alan, still wearing the same Nordic sweater,shirt and tie, his goatee beard as perfectly groomed as a chin dipped in silver paint.

‘Good to see you!’ he whispers, shaking our hands. ‘Thanks so much for coming.’ And he shows us in.

Maud is in the hospital bed in the living room, as before. If anything she seems in better form, alert and smiling, with that copy of Anna Karenina on her lap.
‘Ah!’ she says. ‘Here comes the cavalry!’ putting the book aside.

The last week or so, Maud has stopped being able to stand with assistance and transfer to the commode. There doesn’t seem to be any infection or other organic reasons why she shouldn’t be able to do this. And she certainly has the strength. When we’ve lowered the bed and raised the backrest, she swings her legs over the edge ready for the off. It’s just – that’s as far as she gets. Stacy is great at clearly and firmly describing what Maud needs to do to stand up, even sitting next to her at one point and demonstrating – but Maud just can’t translate it into action. She keeps putting her feet too far out in front, and then waggling them up and down on the carpet, like a child splashing her feet in a puddle.
‘It’s no good!’ she says. ‘I’m falling!’

We persevere for as long as we can, but it’s a game of diminishing returns. The more we try, the more anxious Maud becomes, until her efforts to stand are such an approximate and off-kilter thing, leaning back against our hands, the zimmer frame lifting off the carpet, that we have to accept defeat, and help her back to bed. It’s strange to see how well she lifts her legs back onto the mattress and snuggle down again. Strength is certainly not the issue.
‘It’s definitely a confidence thing,’ says Stacy, snapping off her gloves. ‘Which isn’t any less incapacitating, of course.’
‘No, of course,’ says Alan. ‘So what’s to be done?’
Stacy shrugs.
‘Seems a shame to be thinking about hoisting. But other than that I suppose it’s bed care and some gentle encouragement to overcome the block.’

‘You see that woman over there,’ says Maud, pulling the bedclothes up to her neck, and then pointing straight in front of her. For a second I wonder if it’s another ghost – until I realise she means the sideboard facing her, and an ornate, silver frame in the centre of it. ‘This one?’ I say, going over to take a closer look. It’s a sepia photograph of a young girl standing on a dark, southern English beach. She’s dressed in a billowing white dress and enormous circular brimmed hat, which she holds on her head with one hand as she squints off into the distance. ‘That’s my mother,’ says Maud. ‘Now she’d have known what to do.’

stairway to helen

~ jim clayton ~ Leave a comment

I’ve never seen so many stairs. The whole place is a monument to them, an Escher wet dream of pointless meandering, a riotous architectural celebration of ascent and descent. It’s a shrine to steps, a mounting Mecca, a pilgrimage to Our Lady of the Handrails and Bannisters.

It’s certainly a lot of stairs.

It’s not simply wilful overuse, though. There’s a simple geographical explanation. Helen and Graham’s house is built into the side of a hill. For a start, the road leads down to it at quite a pitch. Then you have two flights of concrete steps down to the front door, a couple of steps over the threshold onto a landing, and then stairs leading down into the lounge straight in front, or up steeply to the right in two flights to the bedrooms and bathroom. The view from the lounge is an impressive, eagle-eye view of the city; I imagine that’s one reason they bought the place sometime back in the sixties.

I’ve come here with Sye, the physiotherapist, specifically to do a stair assessment (Initial assessment? Too many stairs). Helen has just been discharged from hospital after a total knee replacement. If they haven’t given her the robotically-enhanced version, she’s going to struggle.

‘I’ll be alright,’ she says, shifting uncomfortably on the sofa. ‘It’ll just take a bit of getting used to, that’s all.’

Graham is even more dismissive about the practicalities of the thing. There are two enormous, plush leather sofas in the lounge, meeting at the doorway and making a narrow corridor. It’s awkward for us to get through, let alone Helen, but Graham won’t countenance moving things around to make it easier.
‘You’ll just have to pass the frame over and come through sideways,’ he says.
‘Are you sure we couldn’t just move the sofa over?’ says Sye.
‘Where to?’ says Graham.
We make some suggestions. But it would mean losing a coffee table and one easy chair, something that Graham regards with horror.
‘No,’ he says ‘Absolutely not. We’ll manage.’

And to be fair, Helen seems to be the past master at managing. Once she’s negotiated the Clashing Rocks of the sofas, she hobbles on to the bottom of the first set of stairs.

‘Just remember,’ says Sye. ‘It’s good leg up to heaven, bad leg down to hell.’
‘Heaven. Hell. Got it,’ says Helen.
She makes heavy going of the stairs going up.
‘I think we should make camp here’ I say on the second landing. ‘Strike out for the summit in the morning.’
‘No. Come on, now. Keep up,’ says Helen.
And after a great deal of puffing and swearing, swinging her bad leg off to the side like Long John Silver at musket point, we finally make it to the very top landing.
‘Phew!’ she says, catching her breath. ‘You’d think I’d be used to it by now.’
‘You’ve just had a major operation,’ says Sye. ‘Cut yourself some slack.’

On the return, Helen insists on coming down backwards. That’s the way she got used to doing it in the months leading up to the operation.
‘Unorthodox,’ she says. ‘But it’s the only way I know.’
‘Good grief!’ says Sye, as she turns round at the very edge of the top stair, takes hold of the handrails either side, and begins the slow descent.

Back down in the lounge, there’s the same problem as before, negotiating the narrow gap between sofas before Helen can sit back down in her favourite spot. Graham is sitting the other side of the room, watching a natural history programme, something about bats.

‘All finished?’ he says, as a great flock of them swarm out of a giant cave at sunset.

‘I can’t speak for these two gentlemen,’ says Helen. ‘But I sure as hell know I am.’

the old bird

~ jim clayton ~ Leave a comment

‘Really – I’m fine. I don’t know what you’re making such a fuss about.’
Mrs Roberts has a determined, no-nonsense demeanour, fussing with the arms of her jumper to even them out, then sitting straight-backed in the armchair, distributing a brave smile about the room, bright as a lighthouse, to anyone who needed or cared to see. It would be easy to think that here was a ninety year old woman perfectly and admirably in control of her life, if it wasn’t for the livid, green and black bruises extending from her eyes down both swollen cheeks, the stitches on the bridge of her nose, and the bandage on her left hand.
‘You’re not fine, though. Are you, Mum? You’re very far from fine,’ says Steven, her son, sitting in a chair opposite.
‘Rubbish!’ she says. Then turns to me. ‘You see what I have to put up with?’
Steve buries his face in his hands.
‘Are you okay?’ I ask him.
After a moment he emerges again, his eyes shining, his face red. He straightens in the chair, takes a deep breath, and nods.
‘It’s difficult,’ I say. ‘It’s difficult for everyone.’

The situation has many practical angles and complications, of course, but the crux of it is simply the frailties of old age. Mrs Roberts has managed the early years of her ninth decade with impressive self-determination, only needing carers these past six months, when a dip in her mobility meant she struggled to get ready in the morning. It was a carer who found her on the floor just last week – a heavy fall with superficial injuries, thank goodness, but there’s no getting away from the fact that she’s more vulnerable than before. Steve lives in Germany, has done for many years. His brother is in the UK somewhere, but a family rift means Steve is the one left to sort things out.
‘I’ve just got to go back tomorrow,’ he says. ‘Work…life…y’know?’
His mother smiles at him as she gently dabs at her nose with a handkerchief.
‘Don’t you worry about me,’ she sniffs. ‘I’m perfectly capable of looking after myself.’
There’s talk of getting her into a respite bed for a period of recuperation. She doesn’t want to go, but she’s willing to do it if it means Steve can get back to Germany and not worry himself to death.
‘I wouldn’t go for good, though,’ she says. ‘I’m not ready for the funny farm yet.’

There’s nothing in her observations to suggest a reason for the increased falls. She says she feels well in herself.
‘It’ll be interesting to see what the bloods show,’ I say, preparing my kit to take a sample.
Steve asks me how long it might take to get a respite bed.
‘There’s a bit of a wait,’ I tell him. ‘There just aren’t that many available, what with all the cuts. The few they have they triage pretty thoroughly.’
‘It’s just – what’ll happen when I go back? She’s really not safe. Even with the carers upped to four times a day.’
‘If you funded a place independently you could get one more quickly, but of course that’s only if you have the money. Like a lot of things, I suppose. Without getting too political…’
He thinks about that, both hands flat over his mouth, so that I can hear his breath moving over his fingers.
To distract Mrs Roberts I nod at the mirror just behind her. There’s an old, velvet parrot on a perch hanging down in the middle. One of its eyes has gone, and the whole thing leans precariously to one side. It has a tuft of faded yellow fur in the middle of its head, like a comedy wig. I get the feeling if I unhooked it from the mirror and gave it a gentle shake, much of the colour would come back.
‘I like your parrot,’ I say. ‘And that’s not something I thought I’d be saying today.’
‘Percy? He’s a love, isn’t he? Steven gave that to me when he was a little boy. He saved up his pocket money and he bought it at the school fair. Didn’t you darling?’
Steve nods, reaches over and strokes her knee.
‘Looking a bit tatty now, though’ he says.
‘Oh I don’t know,’ she says. ‘There’s life in the old bird yet.’

met

~ jim clayton ~ Leave a comment

Maud’s designated next of kin, Alan, lets me in. A tidy man in his early sixties, his grey beard is as scrupulously clipped and pressed as his Nordic woolly jumper.
‘Just through there, in the living room,’ he whispers, giving a little bow of the head, his eyes closing momentarily behind a glint of steel-rimmed glasses, like a kindly psychoanalyst welcoming a new client. ‘The social worker’s with her at the moment. I don’t suppose Maud will mind the two of you.’

Maud is sitting out of bed in an armchair, still wearing her cat-print pyjamas, looking around with a detached, slightly befuddled air. Beside her, on a hospital table, is a selection of the things she needs: tissues, beaker of tea, remote control, reading glasses, and a copy of Anna Karenina.

I introduce myself. When I shake hands with Maud she holds her hand out limply, looking up at me like someone who thinks they might still be asleep.
‘I can’t believe you’re a hundred years old,’ I say to her, sitting down opposite.
‘Am I?’ she says. ‘Well, then. Neither can I.’
The social worker fills me in on the situation. Maud has Alzheimer’s, but has been coping pretty well with care support and so on. Just recently there’s been a bit of a decline, and people were worried.
‘It doesn’t look like an infection, so that’s good,’ says the social worker. ‘Maud would like to stay in her home, but we’ve just been talking about that, and what we might be able to do to help.’
‘I’m in your hands,’ says Maud, then nods at Alan. ‘You’ll know what to do, won’t you, dear?’
‘It’s whatever you want, Maud,’ says Alan, smiling. ‘But don’t worry. Nothing’s decided til it’s decided.’

I carry out a quick set of observations whilst the social worker reads through the notes. Everything seems fine. Maud seems to be in rude health, considering her extreme old age.
‘The thing that bothers me most,’ says Maud, ‘is I can’t get up the stairs to look after Mum and Dad. And if I can’t do it, who will?’
‘By upstairs do you mean – upstairs? In the bedroom?’
‘Where else would they sleep?’
‘It’s understandable that you’re worried about them,’ says the social worker, pausing a moment to choose her words. ‘But I think they’re safe now. I think they’re pretty much at rest.’
‘I know that!’ says Maud. ‘I’m a hundred years old! I’m not daft!’
‘No,’ says the social worker. ‘You’re certainly not.’
‘It’s just they’re upstairs waiting for me, and I’m stuck down here, and I can’t do anything about it.’

When it’s time for me to go, Alan shows me to the kitchen door. I take this opportunity to ask him what he thinks about Maud. He stops to listen, adopting a thoughtful attitude, supporting the elbow of his right arm with the hand of his left, gently pinching his upper lip.
‘I haven’t met her before,’ I tell him. ‘So I don’t know how much of this is new.’
‘You mean this thing about her parents?’
‘Has she talked about them before?’
‘Off and on,’ he says. ‘I know how it sounds, but I suppose there are two ways of looking at it. One is that it’s all just a symptom of her cognitive decline, some organic disease and so on. The other is to say that perhaps, yes, she can actually see her parents. You might think it odd to hear me say that; other people, in other cultures, with certain religious beliefs, would probably understand it quite well. You see, it’s been my experience in circumstances like this that people nearing the end of life are – how shall I put this? – met?’
‘That’s certainly a different way of looking at it.’
‘It is, isn’t it!’ he says, brightly, patting me on the shoulder. ‘Now then. Good to see you, and thank you so much for coming!’

I walk over the road to my car and throw my bags in the boot. When I turn round to look, Alan’s still there, watching me from the kitchen door.
I wave.
He waves back, then turns and goes inside.

For the life of me, I can’t help glancing up at the bedroom window.

the ghost of bert

~ jim clayton ~ 2 Comments

Godfrey’s son, Ian lets me in.
‘He’s in the front room watching athletics,’ he says. ‘Go on through. I’m just making some tea. D’you want some?’
‘No – I’m good, thanks.’
‘Okay, then.’

An easy start to things – which is why it catches me off guard to find Godfrey in an armchair, his head thrown back, his eyes closed, his mouth slack, his arms by his side and his legs straight out, twitching and jerking.

If there was one thing I learned from all my years as an EMT in the ambulance service, it’s not to panic. There’s always time – even if it’s just a few seconds – to take a moment and see as clearly as possible what’s happening in front of you.

I’ve seen a great many seizures, and of course they vary enormously in presentation, from absences and automatisms to full-body convulsions. Godfrey’s was different to any of those, though. It struck me as the kind of performance you’d give if you’d only seen these things on the telly. He seemed to think it was mostly about waggling his hands at the wrist.
‘Godfrey? Hello! It’s Jim, from the hospital,’ I say, putting my hand on his shoulder.
He immediately stops, straightens up in the chair, wipes his mouth with the back of his hand and shakes his head.
‘Dear oh dear,’ he says. ‘Some kind of nurse you are.’
‘Nursing assistant.’
‘I thought I’d give you a bit of a scare when you come in. But you’re obviously a hard-hearted bastard.’
‘Well at least that’s some kind of heart, anyway.’
‘I can see we’re going to get along.’
‘I hope so. I can always get the big needle out…’
‘Now, now.’
Ian comes in with the tea.
‘You’re not making a nuisance of yourself, are you, Dad?’ he says, handing him a cup. ‘I can only apologise on behalf of my father. I’d say he means well, but I’d be lying.’
‘I’m not getting involved,’ I say, setting out my stuff.
‘Too late. You’re involved,’ says Godfrey, taking a sip of his tea. ‘Ahh! Now then. I suppose you’ve come about this leg?’

Godfrey strikes me as depressed, which isn’t surprising, given the trouble he’s had with his leg. Although he’s elderly now, he’s been pretty independent, living alone, taking care of himself and so on. Now his mobility is seriously compromised, he’s found himself thrown onto the care of his family, which mostly means Ian, being the closest geographically, and carers coming in to help with this and that. It’s obviously as much a torture to him as the pain itself, and it looks like he’s supplementing his Gabapentin and Co-codamol with a little clowning.

‘You wouldn’t think to look at this wreck of a body, but I used to be a diver,’ he says. ‘That’s a hard job. You’ve got to be mentally tough. Not many can hack it, you know, down there in the dark and the cold.’
‘I bet.’
‘I’ve done some things in my time. I remember once we were sent in to find a body. It’d been there so long, the arm came off in my hand.’
He demonstrates, widening his eyes and pulling away from a phantom corpse.
‘I enjoyed the work, though,’ he says, relaxing back again. ‘Kept me busy.’
Ian nods at me from across the room. I can tell he’s heard these stories a million times before.

Godfrey’s quite a handful but I’m warming to him. He reminds me of my Uncle Bert, who had the same mischievous sparkle in his eyes, deliberately saying something provocative and then waiting to see what you’d do. I invoke the ghost of Bert to help me whilst I’m talking to Godfrey, joining in the banter, until it really feels we’re building a good rapport.
‘You’re all right, son,’ he says. ‘I’ve forgiven you for leaving me to die earlier.’
‘I could tell you were all right because you still had your hand on your wallet…’

The phone rings. Ian goes to answer it in the next room. I start filling in the obs sheet. Godfrey turns his attention to the race on the TV.
‘Look at him, running with his arm in a sling,’ he says. ‘That’s good, innit?’
‘It must make it so much harder.’
‘And look at that one,’ he says. ‘Horribly burned.’
It’s a moment before I realise he means the black athlete.
Godfrey grins when he sees the comment has landed. He folds his arms, and watches me.

It throws me far more than the fake seizure at the beginning of the session, and for a moment I can’t think what to say. It’s disturbing and disappointing enough, but what makes it worse is the intention behind it. This is obviously a test, to see if I’m really on his side, part of the crew, one of the gang.
I return his gaze a moment whilst I think.
He’s a depressed, embittered old man in a great deal of pain. I’m not going to pretend that I think it’s okay, but I don’t think it’s going to achieve much if I confront him. In the end I settle for a miserable compromise.
‘You can’t say that,’ I tell him.
‘Oh! Here we go! The thought police. In my own home, too. What’s the world coming to?’
‘It’s just – not a nice thing to say, Godfrey. People are people. You should know that by now.’
‘You and me are gonna fall out, mate.’
‘I don’t care, if you say things like that.’
Ian comes back in the room.
‘What’s happened?’ he says.
‘I said a bad thing,’ says Godfrey. ‘Apparently.’
Ian winces and shakes his head.
‘Once again – I can only apologise for my father.’
‘That’s okay,’ I say, automatically. ‘Don’t worry about it.’
But the way Ian takes his seat again, quietly, with an exhausted hang of the shoulders, I can tell he does.

not exactly Lear

~ jim clayton ~ Leave a comment

Zikri and I have been asked to do an environmental assessment on a patient.

‘What is this environmental assessment? What do they mean environmental assessment?’ says Zikri, saying it so emphatically again and again it sounds like a sneezing fit. He rapidly flips the page backwards and forwards like he’s trying to shake the sense out of it by main force. ‘They’ve already said it’s unhygienic and dreadful. Faeces on the floor etcetera, a terrible mess. What more do they think I can add to that? Hmm? A colour chart?’
I love working with Zikri. He’s a zesty combination of warmly humane and emphatically pragmatic. With his slightly greying goatee and his steel framed glasses, and his habit of staring at you with his mouth slightly open, like he’s savouring everything you have to say, and preparing himself to jump in with warm words of praise or a stinging rebuke. He’s the best teacher you never had. He’d have made a great theatre director, or maybe an oncologist. You could take any amount of criticism from Zikri and still think he’d given you a compliment.
‘He asked Anna to leave. So she did. She wasn’t able to complete the assessment, but she was there long enough to get this much done. Nowhere does it say she thinks he lacks capacity. And now we’ve been asked to go in and do an environmental assessment. I think all we’ll be doing is making him angrier and less inclined to co-operate than he already is.’
Zikri takes his glasses off and pinches the top of his nose.
‘Well, okay, alright,’ he says at last. ‘What time do you want to meet there…?’

*

I’ve been to a great many scenes of self-neglect, both in the ambulance and latterly as a community health worker. But I have to say Mr Frederickson’s basement flat is by far and away not anything like any of those places. In fact, I’d go as far as saying it’s actually very nice. It has a warm, stripped pine floor; walls populated with framed playbills, woodcuts of seabirds, watercolour landscapes, family photographs; quirky, vintage furniture; palms in jardinieres, and a view through a bright sash window of a rich and well-tended courtyard garden. I can’t help thinking we’ve come to the wrong house. In fact I’m so certain that must be the case, I quickly check the paperwork as Zikri makes the introductions.

‘It’s lovely to see you both,’ says Mr Frederickson, shaking our hands and then tying his dressing gown more tightly around his waist. ‘You catch me rather déshabillé, but then I suppose it is the weekend, so perhaps you’ll let me off.’

He’s utterly charming.

Zikri looks at me.

I know exactly what he’s thinking.

Environmental assessment.

‘If you’d be so kind to pass my apologies to your colleague,’ says Mr Frederickson, ‘… the girl who came here the other day. I’m afraid she caught me at rather a bad time. I stood there with my hair all over the place. I must have looked like Lear on the heath. I think I scared the poor girl out of her wits.’
‘No worries,’ says Zikri. ‘We will be sure to convey your apologies’
‘That’s kind of you,’ says Mr Frederickson. ‘Now – how can I help you this morning?’
‘Well…’ says Zikri.

stars in battledress

~ jim clayton ~ Leave a comment

‘I’ve never been what you might call quiet,’ says Elsa, tugging the bedclothes up around her neck. ‘That’s one thing you could never accuse me of. I suppose you’re either a talker or you’re not. You never have to worry about awkward silences with me. It’s just the way I’m built. Like being left-handed. Or having a head for heights…’

I’m waiting with Elsa for the ambulance to come. I’d been sent round for an initial assessment, ECG and bloods. But it was clear as soon as I walked in the bedroom that Elsa was acutely unwell. A closer examination led me to suspect she was suffering a serious internal bleed, so I called 999.

‘They’ll be here soon,’ I told her, putting the phone down. ‘Try not to worry. Meanwhile, I’ll get a few things together…’

*

It’s been a while, now. Three-quarters of an hour.

When I go next door to phone ambulance control for an update, I’m told that they’re doing their best, an ambulance will be dispatched just as soon as one is available – only, people are having heart attacks, strokes…. surely I can understand? I know it’s difficult, I tell him, but the fact remains, we need to get Elsa to hospital as soon as possible. She’s compensating reasonably well at the moment, but I don’t think that’ll last much longer. We’re doing our best, they say. Of course, I say. I appreciate your help.

When I hang up I carefully document the delay.

‘Not long now,’ I tell Elsa, going back into the bedroom.

Before what, I wonder. She looks so fragile, lying on the bed like this, the sockets of her eyes ghosting through the pallid stretch of her face.

‘I’m glad you’re here,’ she says. ‘I wouldn’t want to do this on my own.’

‘I’m glad I’m here, too,’ I tell her, sitting beside her to do another set of obs. ‘So – go on. You were telling me about Stars in Battledress…’

She’d always been mad on the stage, she says. Singing, dancing, doing sketches. And that was what they wanted. A friend of hers put her up to it. She said I was just the kind of girl they were looking for. It was such a shame what happened to her.

‘Why? What happened?’

‘It was a famous murder case. She was on a cruise ship coming back from a show in South Africa and she was murdered by one of the ship stewards. He tried to make out she’d agreed to have sex with him, but then died of a fit or something, and he panicked and shoved her body out of the porthole. They never did find her body. He was convicted, of course. I think he only escaped hanging because of some loophole or other. Died in prison, years later. Funny how these things work out. Poor Gay. She was such a kind girl, a lovely girl. But these things happen, I suppose. On a ship or anywhere else. You’ve just got to be careful and lucky and hope for the best.’

Elsa tells me about the shows she was in. About one in particular.

‘As well as performing, everyone had a job to do. Mine was to put together these wooden steps for the big dance number in the second half. I was just tightening up the screws when someone dropped a curtain pole straight on my head. Knocked me clean out! When I came to there was only a minute to go before I was on. I had no idea who I was or where I was, but the lights came up, they pointed me in the right direction, and I walked out into the light. Anyway, the words seemed to come from somewhere, so it worked out in the end.’

‘When that show was over I moved into the intelligence corps. I remember – we were all lined up in the corridor, six girls in front, about thirty men behind. You can imagine what that was like. I was the last girl to be called forward. When I heard my name I thought – right! I’ll show these men a thing or two! – so I marched as smartly as I could up to the desk, swinging my arms and hips. But you see, what I didn’t realise was there was this rug just in front of the desk, and the floor was highly polished. As soon as my feet touched the rug it flew out from under me and I slid the rest of the way on my aris, disappearing up to my shoulders in the footwell. The Major he stood up and peered over the edge of the desk.

‘Are you alright down there?’ he said.

‘Yes Sir!’ I said, and saluted, flat on my back, and everyone laughed. But it didn’t do me any harm, apart from a few bruises. They took me on.’

The flat door buzzes. I’m relieved to hear it’s the ambulance.

Two paramedics walk in.

‘Alright?’ says one I vaguely recognise. ‘Wait a minute… didn’t you use to work for us?’

naturally three

~ jim clayton ~ Leave a comment

Gemma, the OT, is pregnant. So pregnant, in fact, she gets asked dozens of time a day how much longer she plans on coming in, as if the questioner thinks she’s slightly crazy, and they’re worried they’re going to find her conducting a patient assessment with a baby bumping along behind her, still attached to the cord.

‘Because you really are so big and out front,’ says Faith, stirring her hot chocolate slowly, before licking the spoon and then using it to trace in the air the generous arc of Gemma’s belly. ‘I imagine this means you will be having another boy.’

‘I don’t think so,’ says Gemma, leaning back against the sink. ‘The scan was pretty clearly a girl. But I’d be happy either way.’

‘Ah – you see! But these scans and things, they can be wrong. I had a friend back in Zimbabwe, she was forty-two years of age, and she had one more baby, and she decided enough was enough. So when the baby came she called him Finish, and she went straightaway and had her tubes tied. But then, you see, the next year, because of recanalization or something else I don’t know what – the very next year, she fell pregnant again. And she gave birth to a healthy baby girl. And do you know what they called this baby girl?’

‘Miracle?’

‘No. That would have been a good name. But no! They called this baby girl Stop!’

‘What were her middle names? Please Dear and God?’

‘I don’t know that she had any middle names. No – it was just Stop, I think. So then she went back to the surgeon, and he said okay, okay, and he tied the tubes a little tighter this time, and that was that. Six children, and hardly room to put four.’

‘I’ll be happy with three. I think three’s plenty.’

‘Yes. Three is a good number.’

Faith picks up her hot chocolate and takes a sip, then cradles it ruminatively beneath her chin.

‘But you know something, Gemma – I can’t think of anything in nature with three of anything. Can you? Four legs on an elephant. Four legs on a cat. Two on a kangaroo. But three…?’

‘I think an octopus has three hearts,’ I say, squeezing in between them to rinse my cup at the sink.

‘Ah! Well! There you go, then,’ says Faith. ‘You wouldn’t want to be like an octopus, would you? Although, maybe that wouldn’t be such a bad idea. That’s one thing you definitely need more of with babies.’

‘What – hearts?’

‘No. Arms.’

technical glitch

~ jim clayton ~ Leave a comment

The rush hour has a hectic, drawn-down feel, people hurrying home through the damp streets, clutching their collars against the rain, struggling with umbrellas, the headlights and brake lights of the traffic around them fitfully illuminating the wintry October night.

Arthur is our last assessment for the day. If we’re to be off on time we’ll need to be quick, but so far at least, the omens aren’t good.

To begin with, we just cannot find the damned house.

I’d spoken to his wife June just half an hour ago to let her know we were coming. But now when I try to call her to ask where on earth thirty-eight South Road is, the phone is permanently engaged. We park up outside the block which, on the Satnav at least, bears the flag. There’s a man sheltering in the doorway, smoking a fag. When I ask him for directions he shrugs and taps some ash off to the side, carefully holding the fag cupped in his hand to shield it from the rain.
‘Is that a flat somewhere, maybe?’  he says, shuffling from side to side, glancing beyond me down the street. ‘Dunno, mate,’ he says. ‘Can’t think.’
We go round him, into the offices of what turns out to be a parcel delivery company. The receptionist behind the desk is bright and helpful, determined to find out where number thirty-eight South Road might be.
‘Sorry to bother you..’ I tell her.
‘Not at all,’ she says. ‘Happy to help. One…. moment….’
She taps around on the computer.
‘Oh! Apparently this is thirty-eight!’ she says, setting back and blushing. ‘Sorry – I only started here yesterday.’
‘So – do they live upstairs, then?’
‘No. Maybe. I’m not sure. I thought that was just a storage area.’
The manager comes through – slowly, as if he’d been hiding round the side of a screen and was reluctant to reveal he’d heard the whole thing. He stares at us neutrally as the receptionist explains who we are and what we’ve come for. No, he says. This is sixty-eight. And no, there isn’t an elderly couple living upstairs amongst the boxes, not as far as he’s aware.
‘I’m sure I would’ve seen something,’ he says. ‘Some nibbled cardboard, maybe a hat. But anyway – let’s have another look on the computer.
We huddle round another laptop as he opens Google maps. It seems a bit weird, going into street view for what is effectively the area just beyond the window, but it’s nice of him to try, and so long as June isn’t answering, I can’t think what else to do.
‘Here we are…’ he says.
He zooms in, but unfortunately, a huge truck had been passing the day the Google mapping car drove down South Road, so we’re unable to get any further with that.
‘Not to worry,’ I tell him. ‘Thanks for your help.’
I’m aware of them standing side-by-side at the counter, following us with their gaze as we hurry out into the rain.

Back in the car I try calling June again. This time she answers.
‘Oh,’ she says. ‘Everyone has this problem. I bet you followed your satnav, didn’t you? What the machines don’t seem to realise is that South Road actually starts beyond the traffic lights.’
‘Does it?’
‘Yes! We’re tucked away up here, but that’s how we like it.’
We leave the car parked where it is, because to move it would mean driving all the way round the one way system, which at this time of day would take forever. By the time we reach the front door, we’re both soaked through.
‘Oh dear!’ says June. ‘Is it raining?’
She shows us in to the narrow hallway, where we take off our coats and shoes and go through to a modest sitting room. The house has electric lighting, the sockets and switches so old the electricians who screwed them into place were probably tutting about the Suez crisis.
June is content, though. She sits by the fireplace, as immaculately pearled, coiffed and cardiganed as a minor royal.
‘He’s upstairs in bed,’ she says. ‘Although I don’t suppose he’ll be terribly pleased to see you. What exactly is it that you want to do with him?’
‘We’ve been asked to come in by the care agency to do a bed assessment,’ says Beatrice, the OT leading the assessment. ‘The carers say that the one Arthur’s in is too low, especially with his reduced mobility.’
‘He can hardly stand,’ sniffs June. ‘He’s pretty frail, you know.’
‘Exactly. We want what’s best for Arthur, but at the same time we have to be mindful of the health of the people looking after him.’
‘I know that,’ says June. ‘I know that very well. I’ve got arthritis as it is. It’s not doing me any good, bending down all the time.’
‘Absolutely.’
‘It’s just he’s such a stubborn old so-and-so. I can’t see him agreeing to a hospital bed.’
‘I think we have to try, though, June. Otherwise we’ll just run into more problems further down the line.’
‘Well. If we do, we do.’
‘Shall we go up and introduce ourselves?’
‘I’ll show you the way,’ says June, getting up with some difficulty. ‘Just don’t expect me to run there.’
The staircase rises steeply, past the first floor landing, winding on and up into the gloom of the upper storeys. I’m glad Arthur’s bedroom is on the first floor though, as getting this far has taken a fair while, June struggling to make the climb, putting her good left foot up first, then hobbling up with the right, sliding her hand along the rail, pausing for breath, and then repeating the process again. The nearer we get to the landing, the more distinct is the noise of Arthur’s oxygen machine, whirring and clicking beneath a large, foxed print of Napoleon’s retreat from Moscow.
‘He’s through there,’ puffs June. ‘You go on.’
The notes had described Arthur as a palliative COPD patient, not quite end of life. The ‘not quite’ is a surprisingly optimistic qualifier, certainly from where I’m standing. The ravages of his respiratory illness combined with his extreme old age have left him cruelly stripped of anything resembling flesh. His hands lie outside the covers, and it’s astonishing to see their complex mechanism laid as bare as an anatomical model: the tendons, the ligaments, the veins.
It’s a shock to see him open his eyes.
‘Oh,’ he says. ‘And what do you want at this ungodly hour?’
‘It’s half past six, Arthur’ says June, finally making it into the bedroom and sitting down on a rattan chair that creaks dangerously.
‘Yes. I know. Half past six in the morning.’
‘In the evening’
‘The evening? Have I really been sleeping all day?’
‘Yes, Arthur. You have’
‘Well, I humbly beg your forgiveness, one and all,’ he says. ‘I find my rather straightened
circumstances are not conducive to keeping a proper track of the time.’
‘No worries!’ says Beatrice.
‘I have this marvellous electronic watch, d’you see?,’ says Arthur, slowly lifting up his left arm.  An old Casio digital watch slips down almost to the elbow.
‘Unfortunately it seems to have stopped working,’ he says, gathering it back up to his wrist, and then relaxing his hands back on to the covers. ‘Once upon a time it used to beep’
The business with the watch seems to have exhausted him. His breath comes in and out through his slack mouth, making a dull whistling noise.
The carers were right to be concerned. Arthur is more or less bed-bound, on a low single divan in the corner of the room. I can’t imagine how you would go about washing and cleaning him, creaming his pressure areas, changing his pyjamas. Even sitting him up to drink would be a struggle. When we’ve roused him again, Beatrice explains the situation with great courtesy and clarity, gently steering him in the direction of a hospital bed.
‘They’re very comfortable,’ she says. ‘You can change the position at the touch of a button, sit up to eat or watch telly, raise the mattress at the knee to ease the pressure on your legs, go up and down – whatever! They’re brilliant, really. And then your carers won’t have to worry about hurting their backs. Because if they do, Arthur, they won’t be able to come in and help you, or any of the other patients on their books. And I know you wouldn’t want that, would you, Arthur? Hmm?’
He slowly shakes his head from side to side, the oxygen tube riding up over his ears and back down again. Someone’s put a little scrap of tape on top of his left ear, to stop it rubbing.
‘No,’ he says. ‘I completely understand what you’re saying, and I thank you for coming here and saying it. But I’d really rather not be moved. I’d rather just be left here in peace for now, and everything else can wait. Thank you.’
We try a little while longer to persuade him to change his mind. In the end, though, the best we can manage is to arrange to come back the following day.‘It’s been lovely meeting you,’ says Beatrice, taking his hand in hers and giving it a squeeze.
‘Likewise,’ he says. ‘Only – when you come back – please, don’t make it quite so early in the morning.’

little red rookie

~ jim clayton ~ Leave a comment

It’s too much of a coincidence. I’d put money on that ambulance car parked outside the block being for Adnan. When I buzz the intercom, the voice that eventually answers – not the patient’s – sounds very familiar to me.
‘Well, well! I thought I recognised the appalling handwriting!’ says Ryan, throwing the door wide and grabbing me to him in a great big uniformed bear hug. ‘How’re you doing, man?’
‘I’m good! I’m good!’
‘Yeah – you are!’

It’s been a while since I’ve seen him. Two years, in fact, ever since I left the ambulance service and made the sideways step into community health. I’d run into most of the other crews in that time; Ryan is probably the last.
‘I’d heard rumours,’ he says, showing me into the flat. ‘Tracks in the snow, that kind of thing. I have to say you’re looking well. Horribly well. It’s quite disgusting how well you look.’
‘No nights’ I tell him. ‘That and not having a radio on my belt.’
‘Damned right,’ he says, slapping me on the shoulders again. ‘Completely damned right. Well, well!’
He ambles back over to the sofa, sits down with a great, easeful sigh, as impressively as a tattooed Viking warrior asked to wait out the battle in a chintzy front-room.
‘What’s your involvement, then, Jimmy boy?’
I can tell from his demeanour he’s not worried about the patient. And it’s true – Adnan seems comfortable enough, in the same high-backed chair I’d left him in just that morning, his leg up on a riser.
‘Tinzaparin injections,’ I tell him. ‘A daily prophylactic dose, post knee op. And then just obs and generally making sure everything’s okay.’
I smile at Adnan; he nods and waves his hand in the air.
‘We used to work together,’ I tell him, by way of explanation, but I can see he doesn’t understand.
‘Where’s Rema?’ I say, turning back to Ryan.
‘The daughter? She just nipped out to her car to get her phone.’
‘So – what’s brought you over, then?’
‘It came through as a difficulty in breathing, but everything checked out and it looks more like anxiety exacerbated by abdo pain – which I’m guessing has something to do with Adnan not opening his bowels these past five days or so.’
‘Yep. That’s definitely a thing. The enema should be delivered early this evening.’
‘Great. Okay. So when Rema gets back, why don’t we all have a bit of a review and decide where to go from here?’
‘Sounds good to me. Meanwhile, I’ll do the Tinz.’
‘Excellent.’
And he carries on writing, stopping every now and again to chat and swap juicy bits of gossip.

It’s great to see Ryan again. I learned so much about ambulance work from him – how to take each job as it came; how to recognise when you had time to step back and think, and when you didn’t; how important it was to keep your sense of humanity, and humour, and how to conserve your energy for the long and relentless run of it all.
It was always such a comfort turning up on station for a shift to find out I was working with him. It would fill me with a great sense of security. I knew that whatever happened that day or night (and for some reason, particularly night) so long as I was with Ryan, I’d be okay, and everything would be fine.
I have one particular memory. It was early on in my time as an EMT, and I was still in that phase when every job that came through filled me with horror. We’d been called to an unconscious patient in a pizza restaurant. When we got there the place was in uproar. A gang of drunk teenage boys had gone in for something to eat, and one of them had passed out on the floor. Whilst I tried to figure out whether he was actually unconscious or not (he wasn’t) the others were jumping around, tipping oregano on his head, laughing, swearing, play-fighting and generally getting in the way. I’d tried to be as commanding as I could, but nothing worked. (I can’t remember where the restaurant staff were, and the police certainly hadn’t pitched up yet). Ryan had hung back for a moment, just to see what I could do for myself. When it was clear I’d lost control, he waded in.
‘Right. You, you and you – OUT!’ he’d thundered. And although I admit my memory of the whole thing is probably unreliable, still I think I see him striding out of the restaurant, kids hanging off his arms and neck like rangy dogs round the arms and neck of a gigantic bear, before being hurled off into the night with yelps and barks.

If there was ever a paramedic who deserved his own graphic novel, it was Ryan. I would certainly have bought a copy (and got him to sign it, too).

Rema hurries back into the flat, and smiles when she sees me.
‘Oh – hi! How are you?’ she says, finishing the call she was making.
‘I’m glad you’re back,’ says Ryan. ‘Jimmy was doing his best, but the only Arabic word he knows is habibi.’
And they all laugh so much – even Adnan – I can’t help blushing.