‘Hi, Jim. Doctor Solway. Is this a good time to talk?
‘Absolutely.’
‘It’s about Bill Mason. D’you remember? We talked about him last week.’
‘Bill. Yes. How can I help?’
‘I take it you heard?’
‘No?’
‘I’m afraid he died.’
‘He died? Blimey! I’m sorry to hear that.’
‘I thought you knew. Sorry to break it to you like that.’
‘It’s okay. Poor Bill. He was in a pretty bad way, though.’
‘Apparently when they broke in they found him with his oxygen mask still on.’
‘Oh. I thought they were supposed to be taking the oxygen away, what with him smoking.’
‘I know! It’s sad he died, but at least it wasn’t in a ball of fire along with half the block.’
‘Who found him?’
‘The respiratory team, when they called round to collect the cylinder. I just wanted to ask you a few questions, seeing as you were the last clinician to see him alive.’
‘Sure. Fire away.’

*

Bill has the intercom buzzer by his bed so he doesn’t have to move to let me in the main entrance. His flat door is on the latch, so I let myself in. His Jack Russell, Sniffy, comes gambolling along the hallway to see me, his paws madly clicking and snickering on the laminate floor.
‘Hey there, Sniffy!’ I say, scroffling his head and ears. He immediately rolls onto his back for a more comprehensive fuss – a hazardous gambit, the poor thing being so fat he’s in danger of getting stuck. But with an ingenious flick of his spine and some frantic waving of his paws, he manages to find traction enough to turn himself right way up again as I straighten and make my way into Bill’s bedroom.
‘Hi Bill! How’re you doing?’ I say, putting my bag down.
Bill is slumped across the bed at an angle, so exhausted he can barely find the energy to wave.
Sniffy makes it up onto the bed via a graded and circuitous route, scrabbling over boxes and chairs, eventually wrestling himself across the duvet to put himself between me and Bill. I give Sniffy a good stroking as I chat.

Bill has been on our books many times before, variations on a theme of self-neglect and non-compliance: not taking his medication, not adjusting his diet despite his obesity and diabetes, smoking despite his breathing problems, and in this particular instance, discharging himself from hospital despite a pernicious chest infection and a recent MI. It’s something of a miracle he’s talking to me now, given his SATS.

Bill is wearing a pair of nasal specs, linked by a coiling line of clear plastic to a large cylinder of oxygen standing by the bedside cabinet. Bill has made some attempt to disguise the fact he’s still smoking, but it’s like one of those photo set-ups where you’re asked to look for clues, and the clues are so obvious it’s embarrassing: a new packet of fags resting in the open bedside drawer, one temptingly half-drawn; a cigarette resting in an ashtray, the tip recently and carefully extinguished (I would guess in the half an hour it’s been since I phoned him to say I was on my way); a few strands of smoke hanging on the air despite the opened window.
‘You really mustn’t smoke with oxygen in the room,’ I tell him, patting the cylinder and earning a jealous look from Sniffy. ‘You’ll blow yourself up and the flat next door.’
‘I’m not smoking, Jim. Honest,’ he says, struggling to push himself up in the bed. ‘I’m too whacked to smoke.’
‘Seriously, Bill. You’ll put Sniffy into orbit.’
‘I’m not going to smoke.’
‘I’m just saying. It’s a huge risk.’
I feel his pulse. In fact, none of his observations are good.
‘You should go back to hospital,’ I tell him, writing it all down. ‘Your SATS are terrible, and that’s with the oxygen…’
‘I’m not going back to that place. Never again. No.’
He’s signed all the paperwork, and he does seem to have capacity, even taking into account the low SATS.
‘We’ll check on you a bit later,’ I say, shaking his hand.
‘Thanks,’ he says. ‘Thanks a lot. But don’t even think about calling an ambulance, Jim. I’m not going nowhere. Sorry. It’s just how it is.’
Sniffy rolls off the bed with a thump, recovers himself, sees me to the door.

Outside in the car I manage to get through to Doctor Solway, to report what I’d found and to come up with a plan of action.
‘First thing I’m going to do is see the respiratory team and ask they visit. We need to get that oxygen away. I feel mean about it, but it’s such a fire hazard I don’t know what else to suggest.’
‘It’s annoying,’ says Doctor Solway. ‘He gave me his word. Anyway, on a cruel to be kind basis, maybe Bill will change his mind about going back to hospital when he’s off the pop and starting to struggle. The man’s his own worst enemy. And his neighbour’s, come to that.’
‘I wonder what’ll happen to Sniffy?’
‘The cute little dog? I don’t know. Someone’ll take him in. He always seems to land on his paws.’

The old house is set in a hollow below the level of the road, at the bottom of half a dozen precipitous concrete steps. Either side of the steps, a great tangle of brambles and clematis and honeysuckle wrestle down the slope together, like a green slo-mo wave crashing over the side of a sinking ship.

No-one answers when I press the doorbell, or rap the door knocker, or even when I ring the landline. (I can hear the phone ringing endlessly, hopelessly, somewhere deep inside the house). I find a keysafe on a wall round the side, but when I call the hospital to find out the number, and open it, the safe is empty.

I’ve just got out the phone again to call A&E to see if she’s been admitted, when Mrs Davidson opens the door.

‘Oh! You are in!’ I say, putting the phone away.
‘What do you want?’
‘My name’s Jim. I’m with the Rapid Response team at the hospital. I’ve come to see how you are.’
‘It’s not me that’s ill. It’s that bitch of a woman who’s been hanging around.’
‘Oh. Okay. Erm… would you mind if I came in so we could have a chat?’
‘All right, fine. I really don’t see the point, though. I’m perfectly well…’
She swings the door open and I step inside.
A shabby, down-at-heel place, with that dull and saturating silence you get sometimes in places that don’t see too many people.
‘So what exactly is it that you want?’ she says, dropping backwards into a chair.
I explain about our service, and who made the referral.
‘You had a fall yesterday evening. The ambulance came and got you up. D’you remember?’
‘Of course I remember. They were absolutely charming. Very helpful. But look – that was last night. I’m perfectly fine now. I don’t wish to appear rude – Jim, did you say? But I’d really rather be left alone.’
‘Of course. I can understand that, Mrs Davidson. And I promise I won’t keep you long, or do anything that you don’t want me to do. But I’d really like to check you over again, if that’s okay. Just to make doubly sure nothing’s changed, you know? And then maybe see if there’s any equipment you might find useful to have about the place. To stop you falling again.’
‘All that I need, I have,’ she says. ‘By which I mean my brushes and canvases. The rest is by the by. I’m an artist, you see. It’s what keeps me going. I’ve sold to collectors all over the world. In Bahrain, The Netherlands, Sierra Leone, Washington, Nepal, London…’
‘Wow!’ I say, but secretly I’m not convinced. It’s not just the way her list of places is such a strange mix of countries and capital cities, it’s the canvases themselves. There are examples of her work hung around the room, enthusiastic but crude attempts at flowers, country views, the odd cat.
‘What d’you think of this?’ she says, handing me an unframed picture that’s resting against her chair.
A rose (it says so, in thick black writing along the bottom), the flower looking so distressed I can only imagine she was trying to stab the bristles through the canvas.
‘Watercolour. That’s the medium,’ she says, taking it from me again and storing it back beside the chair. ‘I like the way it runs.’
‘Amazing!’
‘Thank you. Now then – let’s get on with the examination. I don’t want that bitch of a woman across the road looking over the top of the curtains. She’s been coming round a lot, you know. Telling me how to live my life. Saying I’m ugly. Ugly! What business is it of hers what I look like. I said to her, I said I may be ugly on the outside, dear, but you’re ugly through and through you heartless bitch. So now then. What d’you want first? Blood pressure?’

Sometimes it’s exactly the wrong time to knock on a door. You turn up with the best intentions, only to find yourself blundering into a fraught domestic scene, the inappropriately smiling representative of a system that’s catastrophically failed. Sometimes it works the other way, though. Sometimes you knock on a door at exactly the right time.

Like today.

‘Oh my word! You’ve come to us like an angel!’ says Joyce, clapping her hands together, looking about as delighted as someone could be, just a welcome mat away from divine intervention. ‘I was just wondering what to do about Eric’s dressing. And the surgery was busy. And the emergency number they gave me didn’t work – and then you turn up! But that’s just wonderful!’
I float across the threshold, irradiating the hallway with a humble yet deeply affecting grace.
‘Oh Good God!’ says Eric from his riser-recliner. ‘Now what?’

Eric and Joyce are both in their eighties. Whilst Joyce is pretty healthy, all in all, Eric has a whole shopping list of what they call co-morbidities, the combined effect of which means that he can no longer hold a tea cup with any degree of safety so has to drink from a beaker, and has trouble catching his breath when he walks to the wet room and back, and suffers from an increased risk of falls. Still, they’ve made every adjustment and adaptation they can to keep Eric safely at home, and managed to stay positive despite it all.
As I re-dress Eric’s arm, he tells me about an operation he had recently.
‘It nearly finished me off,’ he says. ‘They’d sewn me up and were wheeling me back to the ward when they had to do a quick about turn and rush me back in. I said to them after, I said: you should put a little Velcro flap down there, so you can come and go a bit easier.’
‘Do you know South Park?’ says Joyce, over-looking from the side.
‘The cartoon? I used to watch it. Haven’t seen it in a while, though. Why?’
‘Our grandson brought round a box-set, and we watched a couple of episodes with him. And when he left it here I’m sorry to say we got a bit hooked…’
‘No shame there,’ I say. ‘South Park’s great.’
‘I like the theme tune,’ says Eric. ‘Goin’ down to South Park…d’ow, d’ow…’ playing an imaginary banjo and stamping his leg.
‘Just hold still one second longer, Eric.’
‘Oh. Sorry.’
‘We got to be quite big fans of South Park,’ says Joyce. ‘Look.’
She opens a drawer behind her, takes out a handkerchief, and flaps it open so I can see. In the corner is a picture of Cartman.
‘What d’you think of that?’
‘Amazing!’
‘It’s part of a set.’
She holds it up to the light a second, then folds it up again, flattening it between her hands, and carefully putting it back in the drawer.
‘One of the nurses on the ward gave it to me the day after Eric’s operation. When they wheeled him back in I said Oh my god! They killed Kenny! And she fell about laughing, and the next day she brought me in the hankies.’

Samuel has been given his diagnosis. The consultant told him all about it a couple of days ago, what the blood results indicated, how the chest x-ray illustrated with dreadful clarity the cancerous mass occupying a full third of his right lung and metastasising through his body, fully accounting for the shortness of breath, the sudden and rapid weight loss and the general, marked deterioration. When I arrive at the flat Samuel is sitting in a high-backed chair, staring straight ahead, his hands neutrally in his lap, whilst the family have gathered all around, arranged in height order on the sofa, a grandson perched on an armrest, another on a footstool, a son outside on the drive talking to a neighbour, a daughter-in-law in the kitchen, ferrying tea.
Samuel’s youngest grandson, Josh – a gigantic kid in a khaki gilet, looking as if his massive tattooed biceps have simply blown the arms off a normal jacket – waits a little self-consciously in the hallway with  Buster, a black French bulldog. Buster comes over to give me a sniff, then stares up at me with a mournful expression before turning and leading me through to the lounge. With his protuberant black eyes, large pointed ears and splash of white down his front, he looks like a diligent but slightly annoyed butler, hearing everything, seeing everything, doing his best to keep things in order whilst this extraordinary thing continues to unsettle the routine of the house.
‘Good boy, Buster,’ says Samuel, ‘Good boy.’ He reaches over the side of the chair to pat Buster’s head, who accepts it with a decorous sneeze, and then with one last glance at me, retreats back to the hall, and sits back down beside Josh.

The supermarket orchid: a conspiracy theorist’s dream. You seem them everywhere, those twin, fleshy leaves, the long, flowering stalks, indestructible, scarcely needing soil, let alone water, silently keeping an eye on things from a million kitchen windowsills. The only plant on earth with a chance of survival in Stanley’s flat.

So it’s certainly a measure of the place that even the supermarket orchids have died.

In their defence, though, you would have to think that a supermarket orchid would face better odds being given as a farewell present to an astronaut, spending years in space, and then being set out on a rock on the surface of Mars to make it more homey, than a shelf in Stanley’s flat.

It’s not for want of trying. He has lots of plants dotted around the place – the remains, at least. Nothing survives. It’s even a challenge identifying the original plant from the scattering of papery stalks and the random pots of dessicated fronds.

There’s a shelf of dead plants above the washing machine in the utility room. On top of the washing machine is a hefty ginger cat, one paw draped lovingly over the front of the door as the machine rattles and judders in a manic spin cycle.
‘There’s nothing Rastus likes better than sleeping on the washing machine,’ says Stanley. ‘I think he thinks it’s a big mummy cat.’
‘With one hell of a purr.’
‘Is that it, Rastus? Do you think the machine’s purring?’
If Rastus hears us (or is, in fact, alive), he makes no sign.
We both look at him there for a while, then Stanley tutts, and leads me further down the hall.
‘Make yourself at home!’ he says, gesturing to a living room of dead plants.

*

‘His name’s Bartlefink.’
‘Like the film?’
‘There’s a film?’
‘Oh – no – that’s Barton Fink.’
‘Hmm.’
‘Great name, anyway. Where did you get it?’
Mrs Mann shrugs.
‘I don’t know. He just looked like one,’ she says.
I try to think what she means. If I think of the name Bartlefink, I think of a comic book detective in a raincoat and hat, although I don’t think I’ve ever seen anything like that, so I’m not sure why. To me, this enormous, bouffant chocolate cat with the kind of flat and cross-eyed expression you might see on a creature who’d turned to look at you in the street and walked into a lampost – if anything, at a push, I’d have called it Monstro. And I like cats.
‘He’s got such a sweet temper,’ says Mrs Mann, bending down with an audible crack like her legs don’t articulate so much as break in the middle. ‘C’mon Bartlefink! C’mon!’
Whether it’s me, or he’s normally this contemptuous, it’s hard to tell. But after staring at me a good long while, and then giving one of his paws a peremptory shake in the manner of a street hoodlum who’d cut me for the price of a couple of treats, he about-tails and stomps off into the kitchen.
‘He’ll be in later, you’ll see,’ says Mrs Mann, using me as a counter-balance to straighten up again.

I don’t know, though. The noise of that cat flap sounds pretty final to me.

Jason closes the front door behind me, one hand on the handle and one hand flat against the scratchplate to make sure it clicks-to with the least possible noise. He doesn’t say anything, but waggles a finger for me to follow him down the hall and into the lounge, where he turns to face me with a forlorn look.
We’re not coping he says, in a whisper. It’s reached that point…. I don’t know. She discharged herself from hospital – against advice – I’m sure you’ve heard…
The whole house is eerily quiet, except for Jason’s emphatic whispering, of course – and the loud snores of a sleeping Springer Spaniel draped along the back of the sofa with one front paw and one back paw hanging down the cushions. Immediately above the dog is a giant, blow-up photo of the same dog sitting to attention, its mouth lolling open and its ears back.
Sorry about Clooney whispers Jason. He’s normally a bit brighter than this.

*

Annie stands and watches through the sitting room window as I unlock the keysafe and retrive the key.
As soon as I open the door, there’s a furious barking from upstairs, a frantic rumble of paws down the stairs, and a sandy-coloured Pomeranian rushes up to me.
‘Mutley’s come to say hello!’ says Annie, without moving at all.
I stand as still as Annie as Mutley sniffs my trousers. After a great deal of huffing and blowing, when he’s satisfied enough to back up a little, I crouch down and let him sniff my hand, too. He accepts me – grudgingly, with a screwed up expression on his face, like a hanging judge forced to commute on a technicality.
‘There! He likes you!’ says Annie.
‘He can probably smell our dog,’ I say, standing up again. Mutley growls.
‘Oh! What sort of dog have you got?’
‘A lurcher.’
‘A lurcher!’ says Annie. ‘I love lurchers. Mind you – I love all dogs.’
‘Me too. Within reason. But Mutley’s a beautiful thing. Aren’t you Mutley? Hey? Are you a beautiful thing?’
He lets me fuss his head, then gives a full-body sneeze that lifts him bodily off the ground, and trots off to the kitchen to look for a reward.
I watch him go. It strikes me for the first time that the flat is papered with notices and post-it notes, stuck on doors and cupboards and surfaces, on the fridge and the cooker and various appliances – almost the entire place annotated with boldly written notes, saying things like The carers will make you breakfast and Do not use the toaster and Don’t go outside: Call Wendy first.
‘What have you come for?’ says Annie.
Mutley comes straight back into the doorway and stares at me. Hard.

Mrs Khachaturian keeps the chain on the door and peers through the crack.
‘Leave me alone!’ she screams. ‘Just go away, will you? Why can’t I be left in peace?’
‘That’s fine, Mrs Khachaturian. I’m so sorry to disturb you. It’s just – people are worried and I’ve come round to see you’re okay.’
‘What people? I don’t know any people.’
‘I think the referral was made by your GP.’
‘What GP? I don’t know him. And I don’t know you.’
She slams the door.

Just as I’m wondering what to do next and start picking up my bags, the front door of the neighbour’s house opens and three small girls tumble out, closely followed by a young woman clutching a handful of bags and things.
‘Hi!’ I say.
‘Have you come to see Ivana?’ she says, taking the keys out of her mouth and glancing over my shoulder to keep an eye on the girls, who are busy skipping and jumping over imaginary hurdles. ‘Just wait there a second, Poppy! Don’t run on ahead, darling!’ she shouts, and then to me: ‘Sorry! We’re off to a dinosaur party. Are you from the hospital?’
‘Yep. Do you know much about Ivana?’
She pulls her door to, locks it, and then pushes her hair out of her eyes.
‘Poor Ivana,’ she says. ‘Mia! Honey! You’re scaring the cat! – Yes, I’ve been going in, phew! The last few years, really, trying to keep things going. But she’s been acting so strangely the last few weeks, turning everybody away. Not eating. Not taking her meds. I’ve picked her up from the hospital a few times when she’s gone in after a fall, but it’s always the same story. She discharges herself before they’ve had a chance to sort things out at home – Lauren! I don’t think the cat wants your T-Rex, sweetie! – but it’s got to the stage where I don’t know what to do anymore. Anything you could do would be great…’
‘They sent me round to check her over and get some bloods, but she wouldn’t even let me in.’
The woman shrugs and shakes her head.
Suddenly there’s a violent rattle of a chain, the door behind me opens and Ivana steps half way out, a weird and wild figure in a tattered nightshirt, her hair bound-up in a dirty silk scarf.
‘What is all this noise?’ she screams.
Poppy and Mia stop still, mid-skip.
Lauren’s the closest. She stares up at Ivana, her mouth falling open, and she drops the T-Rex to the pavement where it lands with a plasticky clatter.

Mr Collingwood knows his flat is cluttered. I’m afraid it happened by degrees, he says, as mournfully as the captain of a ship who had the sextant upside-down and ended up beaching in a strange and unmanageable part of the world.
‘Have a pew,’ he says, although his is the only one not covered with books.
‘That’s okay. I’m happy to stand.’
I put my bag down and look around.
‘Can I have a look at your yellow folder?’
‘Be my guest,’ he says, waving me in the general direction of nowhere in particular. ‘A sorry tale, but no doubt you’ve heard it all before.’

At every stage of the assessment he makes variations on the same, grim joke. When I take a SATS reading he says So there’s air in the old bellows? When I feel for  his pulse he says I’ve got a heart? When I take his temperature: I’m not stone cold, then?
As a change of subject, to lighten the tone, I flip the disposable plastic probe cover from the tympanic thermometer and hold it up between my finger tips.
‘See this?’ I say. ‘You see them dotted around patients’ houses all the time. If you didn’t know what it was, you’d think the pixies had been out. The little health pixies.’
‘Let me see…’
I hand it to him.
He places it in the centre of one great, fleshy palm, and holds it up to the light.
I wait for him to say something, but he seems transfixed. After a full minute, I wonder if he’s being incredible mindful, or simply fallen into a cataleptic trance. Suddenly he takes a big, sighing breath, like a whale coming up for air.
‘It reminds me of something,’ he says. ‘A hat, made of straw, that I saw somewhere once…’
‘Wales? Thailand? In a film, was it…?’
‘No-oo. Not that.’
He leans in, moving his great, barnacled snout closer to his palm.

I lean in, too.

Sheila is a square-cut, no-nonsense woman in her seventies, armoured rather than dressed in a stout tweed two piece and a pink turtleneck sweater. With her hair lacquered up into something approaching a helmet, and her substantial breasts impressively coned and cantilevered, she looks less like a Scheme Manager and more like a specialised assault wagon.
‘I’m dead worried about Alfred,’ she says. ‘C’mon. I’ll take you down there.’
She locks up the broom cupboard that serves as her office, and leads me through an endless series of corridors, turning right and left and then right again, to the point where I completely lose track of where we started from, with only the angle of the light and a different picture on the wall now and again to show we’ve made any progress at all. In fact, if it wasn’t obvious that Sheila knows her way to Alfred’s flat without having to look, I’d be tempted to think someone was playing tricks, changing small details here and there after we’d passed, just to see how long it might take before I stop and say Now, just hold on a minute…
‘I don’t understand how this can happen,’ says Sheila, swinging her keys like a jailer, the soles of her pumps squeaking on the lino. ‘He’s from a big family. They’re not all dead. I don’t understand how things can get like this. You see he’s a very private man. He doesn’t like anyone poking around. And that’s half the trouble. You could tell things were going off because his clothes started to get that shine, d’you follow? There was a bit of a haze about him, and not in a good way. He didn’t look well fed. He didn’t look good at all. But everytime we asked if there was anything we could do he said Oh, no! Everything’s fine! I’m all right! But then he started to fall, you see? And we had the ambulance round a few times. And it was only then I got a peek in his room, and – honest to God – I suppose you’ve seen this kind of thing before…’
‘Self-neglect? I’ve seen quite a lot.’
‘Have you?’
‘Yep. A fair bit. And it often comes down to capacity. You know – if someone has the capacity to make decisions for themselves. So long as they understand the consequences. It’s surprising how far things have to go before you can step in.’
‘I don’t pretend to understand.’
‘It’s a difficult area. I struggle with it. I remember going to one woman who lived in the wreck of a car in a ditch.’
‘A ditch?’
‘A ditch. The wreck was on its side in a bank of hardened mud, under some brambles. And that was her registered address. She lived like that for years. Just her and the cats. She had a husband, but he disappeared after a while. Probably into the mud. It was years before anything was done. And then it was only because of the cats. She got too sick to look after them. They went to a place of safety before she did.’
‘In a ditch?’
‘Yep. The neighbours were brilliant. They tried really hard. They used to bring her carrier bags of food and things, and they called everyone they could think of to get her properly housed. But she just didn’t want to know. It was a shock to see her, lying on her side in all that debris. She was holding a torch. And it freaked me out because I used to have that torch when I was a kid. An Ever Ready, red and white plastic torch. I remember how excited I was, using it one bonfire night when we were setting up for the fireworks. And now here she was, holding the exact same torch, with her fingernails all corkscrewing out.’
We stop outside what must be Alfred’s door. Sheila gives me a sharp, appraising look.
‘Hmm,’ says Sheila. ‘Well I don’t know about that. He’s bad, but he’s not in a ditch.’
‘No. Thank goodness.’
She knocks.
Puts her ear to the door.
After a while there’s a feeble sound from inside.
She shakes her head at me, straightens up, calls out It’s only Sheila, Alfred.
She unlocks the door, and we go in.