Not counting the knock on the door or the ringing of the bell, it’s always the fifth thing I do.

The first is to introduce myself. Hello. I’m Jim, from the Rapid Response Service. Affecting a friendly but trustworthy demeanour, ready to show my ID, ready for a variety of responses, friendly to hostile, indifferent to anxious, hilarious to who the hell are you… Sometimes I’ll add a you know – the hospital, if they look nonplussed. The Hospital sounds serious and sensible, carries weight. Everyone knows what a hospital is; Rapid Response can sound like the Marines.

The second is tell them what I’ve come round for. To see how you are, check your blood pressure, temperature, that kind of thing. I’ll probably follow that up with a So – how are you feeling? as I put my bag down and orientate myself to the place, and the circumstances of the visit. Get the relatives on-side. Any pets.

The third thing is to ask if they’ve got a Yellow Folder. The Yellow Folder is the holy bible of the health visitor round here (the care folder, that other really useful book, is almost always blue). The Yellow Folder will have all the notes and obs charts, discharge summaries and clinical assessments, ambulance reports and ECGs, and most helpfully of all, the record sheets each clinician fills in when they visit. Some folders are so thick, covering so many years and conditions, you have a job to open them without everything pitching out on the floor. Others are sweetly arranged, with coloured dividers, and an index in the front. It’s quite an art handling these folders. When things are going well you can talk to the patient about their current situation whilst discreetly filter-feeding information from the various sections. When things aren’t going so well, you feel like throwing the folder out of the window and starting from scratch.

The fourth thing I’ll do is get my stuff ready. The obs kit, stethoscope, anything else I’ll need. I try to put it all out in such a way that I won’t forget it, an ‘equipment dump’, like I’ve seen the fire service run at chaotic scenes. I’ve also got a plastic folder of paperwork, the different sheets I’ll need to fill out. Who knows how many times I’ve said It’s all about the paperwork! as I lay them out in a row, like the NHS version of The Tarot.

And then the fifth thing, the main event, running the obs. I’ll start off by putting a SATS probe on one finger, and reaching for the pulse on the other wrist.
It’s a pivotal moment, when the visit turns from something almost business-like to something more deeply personal. And I’m often struck by the change.
There are lots of reasons why you should physically take a pulse. The SATS probe is just numbers, easily thrown off course by an irregular heartbeat, lurching crazily from slow to fast. Palpating the wrist and counting the beats gives you a clearer idea of the general rate, and you can also tell a lot from the quality of the pulse. But there’s something else, beyond the merely clinical. It’s a visceral thing, a basic but very human kind of contact.  It’s interesting, how such a simple action can have such a profound effect on the relationship. Even with the most difficult patient. Much more than hello, how are you or where’s the folder.
A gentle squeeze at the base of the thumb.
You can feel their heart beating.
Who’d have thought?

Michael is sitting on the sofa in front of a giant plasma screen, the sound off.
‘I’ve come round this morning to do three things,’ I tell him, putting my bag down. ‘The first is to see how you are, to do your blood pressure, temperature, that kind of thing. The second is to take a little blood if that’s okay. The third is to do an emergency shop. How does that sound?’
He nods and manages an approximate kind of smile. He’s very weak. His alcoholism has been getting the better of him lately, and long periods of vomiting and diarrhoea have left him extremely debilitated. He’s only a couple of years younger than me, but his health problems have taken their toll. He uses a zimmer frame to get about the flat, his hair is thinning and grey, and there’s a fragile, parchment-like quality to his skin.
‘My blood pressure will be low,’ he says, bunching up a sleeve. Even that exhausts him. ‘And good luck finding any blood.’
In the end it’s not too much of a problem. The left arm is hopeless, but the right has a cluster of small bruises where the others have gone in, feeding off the one good vein.
I tap and prod about, eventually driven to inspect the back of his hand.
‘Don’t worry too much,’ he says. ‘I worked in a kitchen and the chef ran me through the arm with a kebab skewer. Hit an artery and everything. That was worse.’
I use a super-fine needle. It draws okay. When the tubes are full I take off the tourniquet and stick a piece of gauze on the wound. Once the labels and the blood form are all written out, I pack everything away and get ready to go.
‘So what do you want for this emergency shop?’ I ask him, taking out a scrap of paper to write a list.
He’s distracted by the TV,  a group of animated, highly-coloured women mutely arguing on a sofa.
‘Hm?’ he says.
‘This shopping I’m doing for you. What do you need?’
He touches the gauze on the back of his hand, paddles his fingers up and down on it for a moment or two.
‘A sliced loaf and a litre of Coke,’ he says at last. ‘Diet Coke. Not Fat Coke.’
‘Is that it? No spread? Cheese, cold meats? Fruit?’ I stop before I say anything else. It wasn’t at all the list I was expecting.
‘Maybe one other thing,’ he says.
‘Okay. Go on.’
‘A bag of sugar.’

Not so much rain as an invasive, super-saturating mist. And no point waiting for it to pass – there’s no sign of easing, no break in the clouds – hell, we are the clouds! – no sense of the passing of anything with a beginning, middle and end. Climate change has happened, people. We’ve blundered into a whole new age. Fish will do well, but humans? In these trousers?
There’s nothing else for it. I have to get out of the car.
Hugging my bag and book I run to Mr Norrington’s front door and ring the bell. There’s no porch or any kind of shelter. Even though I stand as close-in as I can, I’m soaked in an instant.
I curse and ring the bell again.
The house is dark. No reassuring lights in the window.
I knock on the door, just in case the bell doesn’t work.
Nothing.
Whilst I’m standing there wondering what to do next, there’s a rowling, gargling kind of noise from the hedge just to the side of the house. A long-haired cat, as wet as a roller in a car wash, walks towards me and plops itself down at my feet.
‘Hello mate!’
I bend down to stroke its head. It’s like showing affection to a mop. The cat tolerates the attention, but I can tell from the set of its mouth and its murderous expression that what it really wants is for someone to open the goddamn door.
‘Me too!’ I say, straightening up and knocking again.
A light goes on.
‘About time!’ I look down at the cat, who rowls once, an intensely crotchety sound.
‘You need a cat flap’ I say to it. ‘Poor thing.’
There’s a pane of frosted glass in the centre of the door. I can make out the shape of Mr Norrington shuffling with his zimmer down the hall towards us. When he eventually gets to the door, there’s a great deal of ineffectual trying of handles and locks, some muffled kind of apology, then he retreats the way he came to retrieve the key he’s forgotten to bring with him from the kitchen.
‘Come on! Come on!’ I say under my breath, hopping from foot to foot. The cat is utterly still, though. It’s gone beyond caring about the water. It knows it couldn’t be any wetter if it had just swum the Channel. I reckon if I wrung it out I could get about a bucket and a half.
Mr Norrington approaching the door again. Some more fiddling about.
What is this place? A bank?
I must admit I’m impressed by the cat’s stoicism. I’m guessing it’s used to being out all-weathers. If Mr Norrington hasn’t seen fit to provide a cat flap, the poor creature must have grown up relying on someone to open the front door.
‘Not long now!’ I tell him. He doesn’t alter his expression, so intensely focused you’d think he was trying to cut himself a flap with his eyes.
At last! The handle drops, the door cracks and Mr Norrington backs up precariously to open it.
The cat goes first, so laden down with water it can barely make it over the step.
‘Whoa! Whoa!’ says Mr Norrington, putting out a slippered foot to stop it. ‘What’s this?’
Amazingly, the cat doesn’t jump over his foot. Instead it simply stands there, dripping on the parquet.
‘I thought it was yours’ I say to him.
‘I don’t have a cat,’ he says. ‘Clear off, why dontcha!’
The cat doesn’t move, and Mr Norrington can’t do anything, so I have to pick it up and put it back outside. It stands there in the rain, and I wonder whether there’s something else I should do. Put it in the car and let it dry off there? Take it down the rescue? But it’s wearing a collar. Someone owns it.
‘Sorry mate!’
The cat gives me one last look, utterly withering, like I’d been planning this all along, and didn’t he know it? Then he turns, gives himself a shake, and heads back into the hedge.

Barbara the social worker tells me about Bob.
‘We’re holding a key, so make sure you take it. I’d bang on the window first though. Just to the left of the door as you look at it. Bang hard because he’s deaf and he won’t hear you. If he’s in of course, which he probably won’t be. He goes out early for breakfast at the cafe on the corner, then spends most of the day in the betting shop, or the catholic church just across the road. He’s got a really strong Irish accent, so good luck with that. And he swears. A lot. Feckin’ this, feckin’ that. But he’s a lovely guy. Used to work with horses.’
I take the key from the wall safe, gather my notes, and head out.

‘Bob? Hello? It’s Jim from the hospital.’
The flat’s dark, and I can’t make out much behind the net curtains.
I ring the bell, then open the door with the spare keys and go inside.
‘Hello? Bob?’
Through a small hallway, then into the main room. A single bed, the covers thrown back. A pair of trousers and a shirt crumpled on the floor, like Bob simply evaporated and his clothes fell away behind him.
‘Bob?’
I check the flat, half-expecting to see him slumped in the large armchair facing the window, or lying in the bath, or collapsed in the toilet. But the place is cold and quiet and empty.

I lock the place up again and stand in the street, wondering what to do.

It’s half past eight – too early for the betting shop, but across the road the iron gate stands open to the church courtyard. Maybe I’ll try there.
‘Good morning!’ I say to a guy hurrying along the pavement to work.
‘Good morning!’ he says. He probably thinks I’m a priest, in my sensible black jacket, black shoes, hugging my black diary to my chest. He stops to let me cross in front of him, so I raise the diary like the good book and go on into the courtyard.

The wooden outer doors are open. Just inside are two glass doors of matching shape. They give with a sigh and I’m through to the main body of the church, a great, vaulted space lined with rows of white pillars, the ceiling richly ornamented with murals of gold and blue and green. The experience is quite overwhelming and as the glass doors gently swing to behind me I stand still, as stunned as if the gigantic fluted pipes above my head in the gallery had suddenly thundered out a chord.
Except – they’re not silent. A wheezy, whirring noise. Someone’s started work over the far side of the church – an elderly woman, vacuuming the carpet in the chancery. She hasn’t heard me come in. When I shout hello she gives a little start and then stamps on the machine like the voice came from there and she’s shutting it up. When I say hello again, she gets her bearings and then stands squinting at me, pointing the plastic nozzle in my direction, like a gun.
‘Sorry to disturb you,’ I say. ‘I’m from the hospital, I’ve come to visit Bob over the road. I don’t suppose he’s here, is he?’
She looks appalled.
‘I’ll get the father,’ she says, drops the nozzle and hurries away.
There’s the sound of keys in locks, door after door being opened and closed, shuffling slippers on stone flags, then nothing.

I stand waiting.

After a while, the muted sound of voices, doors opening and closing again, then the woman appears, followed by a kindly, red-faced man buttoning up a plaid shirt.
‘Him!’ says the cleaner, pointing at me.
‘Hello there – erm – Father,’ I say. ‘Sorry to disturb you.’
He closes his eyes and shakes his head like it’s no bother at all.
‘Sheila tells me it’s Bob you’re wanting’ he says.
‘Yep. I’m supposed to see him on a health visit but he wasn’t in his flat. They said he comes over here sometimes.’
‘He does, he does, so. Poor Bob. He’s getting on a bit these days. Ninety if he’s a day. Would you not think, Sheila?’
Sheila purses her lips and squeezes her eyes shut, like it’s the saddest thing she ever heard. Then she blinks her eyes open suddenly and catches me looking. I blush.
‘So do you know where Bob is this morning, Father?’
‘Well, you see, what it was now, they came and they took him away to the hospital in an ambulance. Last night. He was that bad. Cursing and swearing and carrying on. Well – you know Bob…’
I smile and nod, even though I’ve never met him.
‘But the fire was quite gone from him, you know? Quite gone. A sad change. A month ago they’d have needed one of them there dart guns. For the horses. And a big net. But no – he went peaceful enough in the end. All bundled up in that little chair they have. I’ll be seeing him later this morning. Is there anything you’re wanting me to tell him?’
‘No. That’s okay. So long as I know he’s safe.’
‘Oh, he’s safe all right. He’s in good hands.’
I’m not sure whether he means the ambulance, or God, or both, so I just smile and nod again. Sheila seems to be on to me, though. She frowns and leans in.
‘Did they not tell you he was taken away?’ says the Father.
‘No. They don’t tell me anything.’
‘Is that so?’ he says, placing a hand on my shoulder and turning me in the direction of the door. ‘Poor fellow! Join the club! Hey, Sheila? Shall we have him in the old club?’
I turn to look, but incredibly, she’s already back at the vacuum cleaner. She stamps it on, then stands there, staring in our direction, the nozzle in the air, hoovering up the motes.

‘What’d happen if I had a heart attack in the supermarket? What would they do then?’
Deidre draws her cheeks in, which, without any teeth, means a complete rolling-in of the lower half of her face.
‘Do you mean if you had a cardiac arrest?’
‘Yes. Would they still jump up and down on me?’
‘Well – yes, I think they would.  They’d have to, really. Unless they can see your Do Not Resuscitate order, they’d be obliged to.’
‘Here. Look at this’ she says, shuffling forwards in the armchair and pulling her dressing gown apart, like Superman getting ready to change. Except in this case her chest isn’t emblazoned with a letter S, but a puckered strip of flesh down the centre, like a giant zipper tricked out in wax.
‘They cracked me twice. Once to start the heart and then a few hours later when it all went wrong. Broken ribs, collapsed lung. I was in a bad way. Months in hospital.’
‘I’m sorry to hear it.’
‘That’s why I want two copies of that form. One for the folder, one for the handbag.’
‘Makes sense.’
‘I’m not going through all that again. Months in hospital. Operation after operation.’
She fusses with her dressing gown, uncovering her knee, covering it up again.
‘I watched it all happen, you know. Them working on me. From above.’
‘I’ve heard of that! When you die on the table but you can see and hear everything.’
‘No. I meant the knee. They couldn’t give me a general anaesthetic so they numbed me from the waist.’

‘There! How’s that? Better? Or worse?’
Lionel is standing behind me, massaging my shoulders. I tell him to dig his fingers in, but still he only goes at it feebly, like a baker plaiting a loaf in his sleep.
‘Where’s my back rub?’ says his wife, Jean, from across the room. ‘How come you never rub my back?’
‘Take a ticket and form a queue!’ says Lionel, then whispers in my ear ‘I’ll be for it later. And not in the way you’re thinking. ’
At least he’s forgotten his outrage that I mistook him for his dad when he answered the door earlier. His dad Cecil will be a hundred this year, if he gets over the fall and the infection. Cecil sits in his chair, turning a handkerchief over and over in his hands like there’s a pattern in the fall of it only he can see.
To be fair, seeing Lionel and Cecil opposite each other like this, anyone would be hard pressed to say which one was the patient. In fact, if I’d had to put money on it, I’d have said Lionel. Despite his saucy banter, Lionel looks used-up, like the effort of maintaining this front is drawing on reserves he can’t replenish.
Cecil’s second wife Gloria is comatose on the sofa. What with the police breaking in earlier, the ambulance and now me, the whole family is looking exhausted.
‘There!’ says Lionel, giving me a finishing slap on the back. ‘All done. No extra charge.’
‘That’s great!’ I tell him, rolling my shoulders as if he’s freed them up. ‘I’m definitely coming back.’
‘Don’t get used to it,’ he says, but then stands there looking a little crestfallen.
‘Sit down for God’s sake. You’re making the place look untidy,’ says Jean.
‘See what I mean?’ he says, and gives me a wink.
I finish my paperwork.
‘That’s them in that picture,’ says Lionel, nodding at a black and white portrait on the mantelpiece.
A young man and woman, dancing in a nightclub sometime before the war, the man in a formal suit, the woman in a flouncy dress, both wearing the number seventeen. The man is dipping the woman back; she’s virtually upside-down, her facial expression held in place by her make-up.
‘It was only last week,’ says Lionel, nodding to his mum on the sofa and folding his arms. ‘But I tell you what, that competitive ballroom dancing, it really takes it out of you.’

Peggy is where she always is – sitting in her riser-recliner, legs up, reading the paper. Her head is tipped back so she can see down the glasses perched on the tip of her nose. She’s frowning, too, breathing through her mouth in an effort of concentration. When I come into the lounge the only acknowledgement she gives is a tetchy little shake of the paper.
‘Hiya Pegs! Whatcha reading?’
‘What d’you think I’m reading?’
‘Looks interesting.’
I glance over her shoulder, which annoys her even more.
A feature spread. A dominatrix threatening to expose her clients, or something like that.
‘How are you feeling today, Pegs?’
She sighs and lowers the newspaper.
‘Not good. Why are you here?’
‘I’ve come to do your blood pressure and whatnot.’
‘You did it yesterday.’
‘I know. But they want it doing over a few days to see how it is.’
She holds the paper up again, gives it another shake.
‘And your heart, too,’ I say, putting my bag on the floor and finding a seat.
‘What about my heart?’
‘It’s been very slow lately. The kind of super slow heartbeat you’d see on an Olympic athlete.’
I can’t help glancing down at her legs, raw and oedematous. ‘How are your pins, today?’
She squashes the newspaper down on her lap and snatches the glasses from her nose.
‘I’ve had it up to here, all you people traipsing through the house day and night asking me questions, prodding and poking about. That nurse yesterday was here about an hour. How much longer is this going on for?’
‘I’m sorry you’re feeling harassed, Peggy.’
‘Harassed? That’s not the word I’d use.’
‘You don’t have to have anything you don’t want.’
‘Well I don’t.’
‘Maybe that’s a conversation you should have with your GP.’
‘Him? What does he know?’
‘Anyway. Do you mind if I have a quick feel of your wrist to see how your pulse is today?’
She holds out her hand and I count the beats. The old clock on the mantelpiece races ahead.
‘Forty-eight,’ I say, releasing my hold. ‘It’s regular, Peggy, but pretty slow.’
‘So I’m not dead yet, then?’
‘No. Not yet.’
I start writing out a new column on the obs chart whilst Peggy looks down at me disapprovingly.
‘What pills do you take for your blood pressure?’ I ask her. ‘Do you mind if I have a look?’
‘You don’t have to have a look,’ she says. ‘I know perfectly well what I take.’
‘Okay. Great. What is it then?’
‘That white thing. You know. The fiddly little one.’
‘I wonder what that is? Can you remember what it’s called?’
‘Is this another one of your tests?’
‘I can go and get it.’
‘No. It’ll come to me in a minute.’
‘It’s no bother.’
‘I can see it now. I take it once a day. In the morning.’
‘What’s it called?’
She rapidly sucks her cheeks in and out and stares straight ahead, like an indignant frog dressed in a floral housecoat and slippers.
‘Rasputin,’ she says at last. ‘Now sling your hook’

The Anastos sisters have always lived together. They were young women when the family came over from Cyprus in ’74, only intending to stay for as long as it took for the situation to stabilise. But one thing led to another – or didn’t – and now here they are, two elderly sisters sharing a house in the middle of town.
Twelfth night has gone now, but whether it’s because Juno hasn’t been well, or whether they’re always a little tardy taking the decorations down, still the Anastos’ Christmas window display burns on, out dazzling the lights of the five o’clock traffic splashing home past their window. It hurts to look at it, the haphazard religious figures, farmyard animals, 3D pictures of Padre Pio, all with radiation burns from the fairy lights.
‘That’s quite a display!’ I say as Athena opens the door.
‘Thank you! I think this year is our best. Come in! Come in! It’s Juno you want to see.’
‘Yes.’
And there she is, sitting on a pile of cushions on an old church pew.
‘How are you, Juno?’
She turns her palms up and glances at the ceiling.
‘Sorry to hear you haven’t been well,’ I say, starting to unpack my things. ‘Just fill me in a little, could you? I know you had a fall, but that’s about it.’
Juno starts to talk rapidly in Greek, and I look to Athena for help. They swap a huge volume of words, gesturing at each other, shaking their heads, tutting, sighing, straightening their skirts – until it passes and Athena looks at me again. ‘Her back hurts,’ she says.
‘Okay. And what are you taking for the pain?’
Juno shakes her head sadly and winces as she leans across to pull a bag of meds in my direction. Athena jumps up and takes it from her, cursing, swatting her hands away. Juno pinches her side. The two of them squabble and fight, and then Athena passes me the meds.
‘Here,’ she says.’
I smile at Juno, who sadly shakes her head.
I open the bag and poke around inside.
An assortment of meds, a couple for analgesia. There’s one I don’t recognise, though, and I make the mistake of pulling it out and showing it to Athena.
‘What’s this one for?’ I ask.
‘Okay!’ she says. ‘I’ll call Crystal. Crystal is at college. She’s a smart girl.’
‘Is she a pharmacist?’ But Athena is already too busy concentrating on the dial tone.
Juno sighs and rearranges her skirt.
The moment Crystal picks up, Athena launches into a monologue just as energised as the one she shared with Juno. I’m amazed Crystal doesn’t drop the phone, but instead she’s straight there, spelling out the name of the drug, and Googling it (some words I get). I want to tell Athena I could’ve done that, but it’s too late. After a few minutes of frantic debate, Athena suddenly hangs up.
‘Blood pressure,’ she says, tossing me back the packet.
Juno shakes her head, and presents her palms to heaven again.

There’s no reply when I knock so I push the door open and walk in.
Stella is sitting in her wheelchair with her back to me, bent over with scoliosis, her hair a halo of white in the bright sunshine. It’s not surprising she didn’t hear me. Her hearing is poor at the best of times, but with The Rolling Stones playing at top volume on the radio I had no chance of making myself heard.
‘Stella? Hello – it’s Jim. From the Rapid Response…’
I walk over and gently tap her on the shoulder. She starts a little, then wheels herself round on the spot to look at me.
‘Hello!’ I say, leaning in and waving.
Just a minute…
She reaches over and with shaking hands pulls the lead out of the radio.
There she says. That’s better. Now then.  Start again.
‘I’m Jim. From the Rapid Response.’ I shake her hand. ‘I’ve come to see how you’re getting on.’
Her wheelchair is adapted in the most extraordinary way. A wooden box stuck on the front with insulating tape. Pockets for things. It’s like a mobility aid from an apocalyptic future. Mad Max in a retirement home.
Let’s go through she says.
She scoots forward at an alarming rate, finely judging the width of the doorframe, and when I take a seat at the table she spins round to face me.
Now she says, edging forwards like a cameraman going for the close-up. Who did you say you were?
The expression on her face is extraordinary, half smile of welcome, half gurn of delight, everything intensified by the round and otherwordly colouration of her cataracts, and her ninety-five year old skin. She reminds me of Waldorf – or maybe Statler – one of the two old codgers in The Muppets who sat up in the Balcony and made fun of the show.
It’s kind of you to come! she says, and pats me on the hand.

After the examination we’re chatting about this and that.
Of course, you know how I lost my legs she says, as casually as someone describing how they lost their umbrella. I tripped over on the pavement, fell into the road and a lorry ran over them.
‘Oh my god!’ I say. ‘That’s dreadful!’
She shrugs.
Luckily it was outside a surgery. A doctor came running out with something for the pain. Everyone was very kind. And now here we are, ten years later!
‘However did you cope?’
Well – these things happen. I used to work in a hospital during the war, so I know how it is. Anyway – have you got everything you came for? How am I looking?
‘You’re looking amazing!’
Amazing? I don’t know about that! I’m ninety-five! I think my amazing days are over.

Irene is no more communicative in person than she was on the intercom. She’s sitting on the edge of her bed, hands neatly folded in her lap, staring at the wall. She barely turns her head when I come in the room, and only answers Yes or No or I see. The flat is warm and tidy, nothing out of place. Irene looks like she’s been set down on the bed and left there.
‘Are you sure you wouldn’t want to go through to the lounge for the examination?’
‘No thank you.’
‘That’s fine, then.’
I remember seeing a play by Arthur Miller, A View from the Bridge, when he describes the father’s eyes as being like tunnels. That’s exactly how I feel about Irene. Two perfectly drilled tunnels, running back to a place that would flood with words if it wasn’t for the medication.
‘This is a lovely flat, Irene’
‘Yes.’
‘How long have you lived here?’
‘Not long.’
‘I understand your daughter lives nearby.’
‘Yes.’
‘Is that why you moved?’
‘Yes.’
I unpack my things, write the date on the obs chart, put a SATS probe on Irene’s finger.
It takes a long while for the reading to show.
Even the instruments are struggling.