Alexandra is furious.
‘But who are you?’
‘The Rapid Response Team.’
‘Rapid Response Team? Do you know Kasha?’
‘Kasha? No. Who’s she?’
‘Kasha was here this morning. She took me out, in the wheelchair.’
Alexandra scowls at me.
‘And what did you say you want?’
‘I’ve come to do a health screen. Your blood pressure and whatnot.’
‘Whatnot? Yes – I don’t doubt whatnot. That’s what they all want. And who sent you?’
‘The doctor.’
‘The doctor? But she was only here a minute ago.’
‘That’s probably when she decided to send for us.’
‘Well why didn’t she tell me about it? She could at least have rung.’
‘I’m sorry it’s all so unexpected. Would you like me to come back another time?’
‘No, no. You do what you have to do. And be quick about it.’
She lets go of the door, grabs hold of the kitchen trolley and pushes it ahead of her, rolling heavily at the hips, like a farmer ploughing a muddy field by hand.
‘Do you have any pain today, Alexandra?’
‘You, maybe. Don’t you ring before you visit people?’
‘Sometimes. When I can. It’s been pretty busy.’
‘Busy! That’s no excuse.’
‘I know. I’m sorry. I’ll make sure everyone knows to call first.’
‘I might have been out. Kasha was here. She took me for a walk. In the wheelchair.’
‘Well I must say it was a lovely day for it.’
‘Lovely day.’
She acknowledges the comment with a snort and carries on moving forward.
The room is wonderfully bright, crammed with interesting paintings, books, ceramics. Propped up on one of the bookshelves we pass are two black & white photographs, one of a young woman climbing monkey-style up a palm tree, the other of a young man, at the foot of the same palm, with a ladder.
‘That’s nothing,’ says Alexandra. ‘I was climbing when I was three. I’d be up the top in no time, throwing down coconuts.’

‘Now listen. Are you listening? Oy – what is wrong with this thing?’
There’s the sound of banging, like Ben’s put his mobile phone on the table and started banging it with the heel of his shoe – and suddenly the line goes dead.
I hold the receiver away from my ear, gently hang up and then dial his number again.
It rings and rings and rings.
Is it broken?
Or has he put it down and gone off somewhere?
Just before I decide to hang up and try again later, he comes back on the line.
‘What?’ he bellows.
‘You rang me, Ben. And then we got cut off.’
‘Oh yes? Well. Now. Yes. Tell me. What do you propose doing about the situation?’
The situation is his sister, Beth. At eighty-one she is five years younger than Eric, but her health hasn’t been good lately. A few weeks ago she fell and broke her arm, which made the basics of day-to-day living pretty complicated. We’d already been in to see her a number of times, and then discharged her from our services once we were reassured she had all the equipment, follow-up appointments, day centre visits and other referrals she needed. Yesterday we heard she wasn’t coping again.
Eric, her only living relative, lives miles away. He was there in the flat with Beth when I went in for the first time all those weeks ago. Despite his wild manner – something he obviously got as a job lot with the wild eyebrows and beard – we got on well.
‘I recognise your voice, young man,’ he says. ‘You’re the one who lives in that godforsaken village. You have some kind of dog, don’t you? And you like to write.’
‘Yes! And you have an old black cat called Jaime, and you still run your own print shop.’
‘Enough of that!’ he says, as if I’ve radically overstepped the mark. ‘Now, Jim – listen to me. It’s vital we sort things out here. Beth is not coping so well. She’s panicking, Jim, she’s panicking. And when she panics, she goes all over the place.’
‘All over the place?’
‘Yes! Last time she had to be brought home by the police. Now last night my son was able to go down and stay with her, but he has his own life and can’t be expected to do this every time. So now I’m wondering what you can do to help? Eh? Because we can’t go on like this. Something will happen and it will not be a good something.’
Each time he takes a breath, I try to jump in with a question, but each time he comes straight back and talks over me.
‘I know what you’re going to say. You cannot do this or that because you haven’t the money, or it’s not the kind of thing you do, or you’ll have to refer her to some other place. But I’m begging you, Jim – I’m begging you. Please. Take some action. Sort this problem out. Because if you don’t, I think the consequences will be most serious.’
‘Ben, I …’
‘We have a care home ready to take her. A nice Jewish place. They tell me they are happy for Beth to stay for a week or two, to help her find her feet and make her confidence to grow again. But of course this is all funding permitting. D’you see? So how do you propose we do that? What is your suggestion?’
I seize my chance.
‘Let’s take this one step at a time,’ I say.
‘One step at a time! Now – Jim. Are you reading from a script?’
‘Me? No!’
‘It sounds to me as if you’re reading from a script. First this, then this. One step at a time. And so on. Look. Jim. I’ve met you before and I trust you will do the things you say you are going to do.’
‘Good.’
‘So please. Put down the script and talk to me. Make your own words.’
‘Ben – honestly. I’m not reading from a script.’
‘No script! Okay? So tell me. What are you going to do about Beth?’
As steadily as I can I review the situation. Beth is safe this evening. Beth has an appointment at the day centre first thing in the morning. This buys us a little time for the social workers to investigate respite care and funding options.
As I’m working my way through these things I can hear Ben breathing heavily into the mobile.
‘Okay. Okay,’ he says at last. ‘Fine.’ Then he sighs, so violently it’s like the mobile phone has exploded in his hand.
Silence for a moment.
‘Ben? Are you still there?’
‘Aye’ he says. ‘Well. Gam Zeh Y’a’vor, I suppose.’
‘What does that mean?’
‘This too, shall pass.’

In a rare coincidence, three separate teams have arrived at Lily’s house at the same time: carers, occupational therapists and me, the assistant practitioner. It’s a small house, barely room for Lily, her husband Denis and her son, John, let alone five other people, each with their bags of equipment. The OTs have even got a bed-rail to be fitted.
‘Who else is coming? The army?’
‘Yep. But don’t worry. They’re lowering themselves down from a helicopter.’
‘Oh. I see.’
Lily lives right on the western fringe of our area. I’m guessing that everyone’s made the same calculation: do the furthest one first. Consequently, none of us is in a position to say I’ll come back later. We’re all on a tight schedule. It’s now or never.
We work round each other. It’s like one of those puzzles where you have to think three moves in advance of the move you want for yourself. We stash bags strategically, move furniture, hand each other things if we happen to be near them, the whole thing like an improvised game of Twister. Lily’s husband has dementia. He gets moved from seat to seat (along with the seat), each time landing placidly and looking over the whole mess with a wintery blue vacancy.
‘Are you going to be long?’ says the son, John. ‘Only I’ve got things to do.’
Despite our reassurances, Lily is getting more distressed. She hasn’t long been out of hospital. Getting discharged must have been a huge relief, but now it must seem as if the hospital has simply followed her home.
‘Now – I just need to do a quick ECG,’ I tell her. ‘Could we clear the room for a moment whilst I stick on the dots?’
Everyone but Denis finds a route out. He sits on his seat, watching, his stick  planted in front of him.
‘And the last dot goes round…here. Thank you. Now then. Let’s see how it’s looking.’
‘Wobbly,’ she says, and glancing over at Denis, she takes a deep, sad breath.

*

That first appointment sets the tenor of the day. I race around town, fighting to cover all my appointments, struggling to get my head round the complexities of each case, the social aspects, medication regimes, observations and their significance, writing up my notes, figuring out what each patient needs.
Back at the hospital, it’s obvious everyone’s had a similar day. We’re coming in like bees to a hive, doing our little dances, handing over intelligence.
The co-ordinator for our team looks unhappy. He doesn’t meet my eye when I go through my patients. The stress of his position inevitably means he has to strip each patient down to the bare facts: NEWS score (the higher the score, the sicker the patient); whether you did what you were down to do; can they be discharged?
‘The ECG didn’t show anything new. AF, that’s it.’
‘Did you take the ECG to the surgery?’
‘No. There wasn’t anything acute.’
‘You’re supposed to take ECGs to the surgery.’
‘Well. Okay. I didn’t know that.’
‘No-one told you?’
‘No.’
He shakes his head. Jabs a note onto the database.
‘If there had been acute changes I would’ve taken it round,’ I say.
‘That doesn’t matter,’ he says, leaning back in his chair, still not looking at me. ‘You’re not a doctor. You’re not supposed to interpret these things. If Lily dies it’ll be your fault.’
‘Fine!’ I say, flaring. ‘Put me down for Lily’s death. And if you have a heart attack going home tonight, put me down for that, too, because maybe I was the last one to talk to you.’
‘It’s a responsibility,’ he says. ‘You’re supposed to take ECGs to the doctor. That’s it.’
‘So what am I? Just someone who carries stuff around?’
He shrugs.
‘If something happens…’

I finish handing over my patients, glacially polite.
Gather my papers together and go to the folders cabinet to file them away.
Ellen the pharmacist comes over and asks if I want a cup of tea.
‘That would be absolutely wonderful.’
‘How do you take it?’ she says, then smiles warmly. ‘The tea, I mean.’

On top of everything else, Jenna’s mum has picked up a C. Diff infection. The subsequent diarrhoea has made her condition even more difficult to treat. As a service we’ve been sending in two people at a time, four times a day, as well as providing a hospital bed, commode, zimmer frame, washing equipment, sanitary supplies. Even with all this help Jenna is only just about coping. It’s horribly stressful for her. I can tell from the pale, taut expression on her face she’s coming to the end of what she can bear.
I’ve been sent round this morning to check on how things are going. It coincides with another liberal bowel movement, and as I’m on my own, Jenna helps me clean her mother up, change her pads, the sheets and things, and make her comfortable again.
They have a dog, Rufus, a solid, brindle-coloured Staffie. He always comes to the door with Jenna, gives me a stare then a grudging little sniff and nod of the head – as much like a doorman at a fancy hotel as any dog could be without a braided jacket and cap – then turns and leads us both into the front room where Jenna’s mum is living these days.
We’re half-way through cleaning her up, fistfuls of wipes, a bowl of soapy water, towels and pads, struggling to keep the whole dreadful mess in some kind of order, when Jenna laughs and tells me to look. I turn round and see Rufus, lying on his back on the sofa, all four legs sticking straight up in the air.
‘He thinks he’s next,’ she says.

‘Sixty-six years we were married. That’s him up there, in his uniform. I didn’t know him then. I only knew him after, when it was all over. I was working in the post office. His mum used to come in all the time. She said I ought to meet her son, James. I didn’t say anything one way or the other. But then one day when I finished work he was out there, leaning on the railings, smoking, looking handsome. And he said did I want to go out Saturday, and I said why not. You never think, do you? And now look! Children, grand children, great grand children. See that one, there? New Zealand! Jimmy never used to talk about the war, until later. Something stuck in my mind, though. He said there was a wreck once, and there were people, drowned, floating upside down, so all they could see were their feet. Do you think that’s possible? How would you even see their feet, in the waves? It upset him, though. Upset me, too. But it’s not the kind of thing you think about, is it? Poor drowned people, upside down, in the waves?’

Colin’s blood pressure is so high I almost have to nip his arm in two before the systolic reading ebbs away.
‘For chrissakes can’t you stop? You’re killing me!’
‘Sorry, Colin. There – all done. I’m afraid it’s pretty high.’
‘I told you it would be. It always is when they do it.’
‘When was the last time?’
‘The last time what?’
‘The last time they did your blood pressure.’
‘Well – the last time they was here, of course. Sylvie – you tell him what he wants to know. I can’t make head nor tail of it.’
He looks over at his daughter, Sylvie, who is sitting over by the window, rubbing her hands anxiously, smiling the kind of smile you might hold in front of your mouth on a stick.
‘Dad doesn’t like having his blood pressure done,’ she says. ‘It always goes high.’
‘Two hundred and twenty over a hundred and five is pretty high. If it went untreated you’d be at risk of stroke.’
‘I don’t want that,’ says Colin. ‘Just give me a ticket to Switzerland, that’s all I want. I don’t want to be no bother to no-one. You got to know when your time’s up.’
‘I’m sorry you’re feeling like that. Have you been taking your blood pressure medication?’
‘Me? No!’
‘Why not?’
‘It’s not doing me any good, that’s why not. They put you on all these tablets. Half the time they don’t know what they do. And then they just expect you to keep taking ‘em without another word for the rest of your life. Well I’d had enough of it. So I decided not to bother no more.’
‘How long ago was that?’
‘About a month.’
‘I think that’s probably why your blood pressure’s crept up, then. I think you should go back on the meds and then speak to your doctor about your prescription. There are lots of different types. If you don’t think this one’s right, there are plenty more.’
‘But you can’t tell me?’
‘I could tell you roughly, but your doctor’s the expert. They’re the ones in charge of your medication.’
‘But not you?’
‘I’m not a doctor.’
‘No. You’re not, are you?’
He shifts in his chair, flinching and muttering. When the pain of that position change eases, he starts on again, jabbing his finger in the space between us like he’s trying to shake something off.
‘Well maybe you could explain this to me, then,’ he says. ‘Years ago, we never had all this. You never used to get all these people sitting about the place taking handfuls of pills. It was all fresh air and decent food, and a job of work to do. Not all this…’
He gestures to the room, the zimmer frame and commode, the bed strewn with tissues and wipes, remote controls and magazines.
‘… all this fuss’ he says at last, helplessly. ‘I mean, what happened to all them people?’
‘They died,’ says Sylvie. She looks utterly forlorn for a second or two, but then finds the smile and holds it up again. ‘You’ve got to take your meds, Dad,’ she says. ‘You never told me.’
‘What are you writing?’ says Colin, ignoring her.
‘I’m just putting down a few things in your notes. Your blood pressure, pulse and what have you. The fact you stopped taking your blood pressure pills.’
‘Fact? Wha’d’ya mean, fact? I never said I stopped taking them. I just said they weren’t agreeing with me, that’s all. Don’t you go getting the wrong end of the stick, writing a load of lies and getting me into trouble.’
‘It’s not a question of getting you into trouble, Colin. We’ve just got to figure out the best way to help you. If you don’t want to take your meds, you don’t have to. It’s a free country.’
‘I tell you another free country,’ he says, folding his arms.
‘Where’s that?’
‘Switzerland.’

With his basin haircut curling under his ears, Edward wouldn’t look out of place in a stained glass window – the Patron Saint of Neglect. He hasn’t shaved in a while, but his beard is still only a few wispy sprouts;  he seems to have paid more attention to his eyebrows, though, plucked into delicate arches, giving his slack face the expression of a man used to disappointment. His flat is filled with porcelain fairies, plastic orchids in brass urns, alabaster cherubs, prints of Victorian scenes – everything covered in a thick layer of dirt, half dust, half nicotine.
‘Would you mind not smoking, Edward?’
He grunts, but pinches off the end of his cigarette.
‘Thanks very much. I won’t be long. So – how are you feeling today?’
‘Bloody awful,’ he says.
‘Oh? I’m sorry. In what way awful?’
‘Me feet, me legs. Me back don’t half hurt. I’ve got pains in me sides, here and here. I’ve got these shooting sensations into me chest. I can’t eat. I can’t sleep. My head’s all woozy and stuffed up. Apart from that, I’m fine.’
He gives another little grunt, jerking back a little and resting his eyes on me just long enough to check that I got the joke.
‘Well I tell you what, Edward.  How about I run through a set of obs, and then we’ll have more of a chat about what’s going on? How does that sound?’
‘You do what you like,’ he says, and rolls up the arm of his dressing gown. ‘You people generally do.’ Amongst the blurry old tattoos, the outline of multiple ECG dots on his skin.
‘The intercom don’t work,’ he says. ‘When the council come to put a new door on they cut through the cable. My phone don’t work, neither. That was nine months ago.’
‘Nine months? Have you told them about it?’
‘They don’t want to know. They give me this number to ring. BT or someone. But I said to them: How am I going to ring BT if I haven’t got a phone? They didn’t have an answer to that. Well, Gerald, this so-called friend of mine, he came round and he said why don’t I lend you my phone and you can call them on that? So I dialled the number, and I explained the situation. And they said it’d cost a hundred pounds to get it re-connected. How am I supposed to get hold of a hundred pounds? I said. You might as well say a million. So then Gerald, this so-called friend of mine, he said he’d lend me the money to get a mobile phone from Tesco. They only cost a tenner he said. You could have it on you all the time. But I said to him, I said How am I going to get to Tesco? Well, he said he’d take me on the bus, but I said with these legs? What was he trying to do – kill me? So then he said he’d go over and get it for me. So he did. But when he come back, I didn’t have nowhere to put it, and anyway, the buttons were too small, and I kept losing it down the sofa. Gerald, this so-called friend, he ended up buying another one, but then it turns out you’ve got to keep it charged up, and I’m not made of money. Not that anyone calls,’ he sniffs. ‘Specially not Gerald.’

‘The doctors don’t know what’s wrong with me and they don’t care.’
‘I’m sure they do care, Marjorie. It’s just they’re really busy. Not trying to make excuses or anything.’
‘The carers are the same. They come in, they go out. Sixteen minutes and that’s your lot. No-one wants to sit down and talk. And even when they do, they don’t want to listen.’
‘It’s difficult, isn’t it? When they have so many patients to see. No-one likes it. It’s symptomatic of a system under strain.’
‘Could you pass me that cardigan? Not that one, the other one.’
I drape it round her shoulders. She shrugs it on a little closer, her face slack with a depression as irresistible as gravity.
‘Do you have any family in town, Marjorie?’
‘There’s just one son left to me now. The one who never liked children. He’s an accountant. He chose that path in life. He doesn’t know what to do with me.’
‘I’m sure it must be hard on everyone.’
‘I had a daughter, but she died.’
‘I’m sorry. What did she die of?’
‘Cancer. Of the brain. She went to the doctor with these headaches. Sinusitis the doctor said. By the time they scanned her the tumour was as big as an egg. Dead in a month.’
‘That’s awful.’
‘And now this. I used to go down the day centre, but now I just sit indoors all day. I made some friends but they’re all gone. I’ve had every test you can think of. I’ve had cameras up me. They’ve taken no end of blood. Opened me up and rummaged around like a suitcase at a jumble sale. Looked at my heart. You name it they’ve done it. And they still can’t make up their minds. They put me on these water tablets but they haven’t done any good. I’m swelling up like a balloon.’
‘I think sometimes it’s difficult to figure out what’s going on. It’s not always straightforward. The next appointment might be the one that makes the breakthrough.’
She snorts, and grinds me into the carpet with her eyes.
‘You think?’

Wendy’s house is filled with the faces she’s painted over the years, portraits of old men, young girls, mothers and their babies, soldiers and their rifles, businessmen, socialites, farmers, priests – a fascinating array of characters from Wendy’s long life and travels. The hard fact is that now, the artist barely recognises herself.
‘Who sent you?’
‘The doctor.’
‘Why on earth would they do that?’
‘I think they want to make sure you’re okay.’
‘Of course I’m okay. I’ve never heard such nonsense.’
‘Is there anything I can help you with this morning?’
‘Such as?’
‘Well I don’t know. What do you feel like? Would you like to have a wash and get dressed?’
Wendy’s still in her dressing gown. It’s been a while since she was in anything else.
She glances at her friend Pamela, sitting next to her on the sofa.
‘What is this all about?’ she says. ‘Who is this man?’
‘It’s Jim. From the hospital. He’s come to help you with things.’
‘Help me with things? How ridiculous! I don’t need help.’
The trouble is, she really does. And if the jury’s still out on the cause of her acute onset dementia, there’s no doubt about the effect. Everyone’s rallying to the cause – her family, neighbours, health and social services. People have been remarkably kind, sitting with her, holding keys, doing what they can to keep Wendy going. But her confusion is reaching a point now where the basics of living are becoming impossible to maintain, and there are growing concerns for her safety. And Wendy sits in the middle of it all, a bewildered figure in a red silk, poppy-patterned dressing gown, one hand folded in the other, looking around with preternaturally blue eyes.
‘Who sent you?’ she says.

Walter became unwell and fell over earlier in the week, and the doctors still haven’t been able to find out why. Walter’s in his late eighties, but despite the depredations of old age and this recent bout of ill health, he’s managing to stay pretty stoical. A scientist all his life, his curiosity is bracing.
‘Neutrinos!’ he says, unexpectedly, as I prepare the kit to take some blood. ‘Do you know what a neutrino is?’
‘Absolutely no idea. Isn’t that what they’ve been chasing round the Hadron Collider?’
‘In a way, yes. Of course it’s most famous for the Higgs-Boson, but it’s exploring and testing particle physics generally.’
‘Sharp scratch…’
‘And what is the purpose of this blood test, you say?’
‘It’s a general screen to find out if you’re having any problems with renal or liver function, if you’ve got an infection, that sort of thing.’
‘I see.’
‘You know this Hadron collider?’ I say, drawing off the blood.
‘Yes.’
‘Didn’t it suffer some catastrophic failure because a bird dropped some baguette in it?’
‘It’s had a few technical problems. I don’t know so much about the bird. But you see, a machine of that size and complexity is quite a proposition.’
‘I bet.’
‘It’s many miles long. Through a mountain.’
‘So you wonder how the bird got close. I mean, don’t they have covers on the vents?’
‘I’m sure they do. The point is, it’s already pushing the boundaries of what we know physically about the world. The very essence of being.’
‘Well – here’s some of your essence.’
I hold up the two phials of blood.
‘Thank you. It will be interesting to see what changes there have been, if any.’
I put them into the pathology envelope and seal it.
‘Did you ever meet anyone famous?’ I ask him, packing away. ‘Did you ever meet Einstein?’
‘Einstein? No. But I did meet Heisenberg. Have you heard of him?’
I want to say ‘Breaking Bad’, but don’t.
‘He was most famous for the Uncertainty Principle.’
‘What’s that?’
‘Basically he postulated that it’s impossible to know both the position and momentum of a particle with any precision. He wasn’t like Newton, you see, who thought that once you knew all the facts the universe would reveal itself to you like some gigantic mechanical clock. It’s much woollier than that. And more interesting.’
‘So what was he like?’
‘Who?’
‘Heisenberg?’
Walter rolls down his sleeve and shrugs.
‘Fat,’ he says. ‘Very fat.’