ETOH

It’s quite a contrast to see the two of them together – Alex, wraith-like, matted hair, scooped eyes, shivering, hugging his legs in bed with a filthy duvet piled up around him; and Graham, the support worker from the alcohol and substance abuse team, shaven-headed, gym-fit, in a smart grey reefer jacket and leather man bag, perched on the arm of the sofa with his hands in his pockets. It could be a fashion shoot for an edgy magazine.
‘You’ve got this far, yeah?’ says Graham. ‘Hats off to you, mate. It’s no easy thing you’ve done there. Don’t go and spoil it now. After all we’ve been through. You got to realise – this is a disease we’re talking about, yeah? There are all kindsa toxins and shit floatin’ around your body right now. You can’t just expect to jump up and be cured. It’s a long, hard process. And you’re doin’ great, man! Isn’t he? This guy’ll tell ya…’
‘You are. Graham’s right. Alcohol addiction’s the hardest thing.’
‘See what I mean?’
Alex doesn’t seem convinced. He draws his legs closer to him, gives his head a peremptory shake.
‘I don’ know, man. I jus’ feel like I’m wastin’ everyone’s time. I mean – I brought it on myself.’
‘You can’t afford to think like that,’ says Graham. ‘Everyone’s different. You’re totally worth it, man.’
‘Is there a social worker involved?’ I ask Graham, flipping through his folder.
‘No,’ he says. ‘When they see they’re still drinking they pull out.’
He shrugs, scuffs his shoes in the trash.
‘It’s hard, but it’s just the way it is.’
‘It’s not like I’m not trying,’ says Alex.
‘Yeah – but there’s trying, and there’s doing, Alex. You’ve got to be in a position to accept the help. It’s just how it works. You know that.’
‘Yeah.’
‘We’re here for you, though.’

There are several bottles within easy reach of Alex’s bed – a two litre bottle of cider, a couple of quarter bottles of vodka, some other, less obvious stuff in bottles with the labels torn off. A dull yellow light filters through the filthy windows. The flat is an apocalyptic mess; it looks like an extemporary shelter somebody hollowed out with their hands in a landfill site. Here and there you can just make out traces of the orderly life Alex once used to live. There’s a mountain bike in the hallway, quietly fossilising under a press of junk; over by the window-ledge, a tool box, some work boots.
‘We’ve got to find a way to keep you out of trouble long enough to detox properly,’ says Graham. ‘Yeah?’
‘Yeah,’ says Alex. He doesn’t sound convinced.
Graham shrugs, pushes his hands deeper into his jacket.
‘How long’ve we known each now?’ he says. ‘Gotta be nine, ten years.’
‘Is it?’ says Alex, rubbing his face. ‘Fuck, man! Nine years? No! That’s like…’ He screws up his face to figure out what percentage of his life that represents: ‘…that’s like… a fuck of a long time, man!’
‘I think so,’ says Graham. ‘First time I met you you’d just been beaten up and taken to hospital. You were in a bad way, my friend.’
‘Was I?’ says Alex. ‘I don’t remember.’
‘Yeah – well – you don’t remember much, to be fair. You didn’t remember I was here yesterday, so maybe that’s not headline news.’
‘No. You’re right. Probably not.’
‘I’ve seen you in and out of hospital a hundred times. Lost sight of you for months on end when you took yourself off somewhere. You’d always turn up again, half dead, some new injury. And now look.’
He’s right. I’m reading through the latest discharge summary. For someone so young, Alex has a terrible list of things wrong. In fact, it’s a miracle he’s still here at all. Looking at him on the bed, though, it would be easy to think that maybe he wasn’t – that maybe he’d died that last time in hospital, but his spirit was so cussed it dragged itself back across town to find rest in this cold, cold bed.
‘It’s like training, yeah? You can’t just jump on a treadmill and bang out ten K. You might feel great at the end of it, but the truth is, if you don’t get the intervals right you can be setting yourself up for a lot of trouble. It’s all about the interaction between the sympathetic and the parasympathetic nervous systems, the way your body metabolises the shit and tries to get straight again. Jim’ll tell you. Hey?’
They both look at me – Graham as if he’s about to pick me up and bench press me, Alex with a haunted, shivery look.
‘That’s right,’ I say, ‘Uh-huh.’

mandy’s eyrie

Mandy’s flat is at the top of the block – so much so that the lift doesn’t extend there, and we have to walk the last two flights. It makes me think of an osprey’s nest, a junky bundle of sticks wedged in the uppermost branches of a pine. The nest is made up of old music magazines, Janice Joplin posters, empty cans, unpaid bills, unopened nutritional milkshakes, and the osprey itself is a haggard, featherless old bird, smoking a roll-up, staring unblinking over the city.

‘I’m a singer’ Mandy says, her voice so broken she can hardly talk. ‘Or was. ‘scuse the mess.’

She offers us a seat – a dirt-shined cushion in a sixties wicker chair, and a spot at the end of the crapped-up sofa. Standing isn’t an option, but at least this is the last job of the day.
‘Thanks’ I say, and we both – slowly – sit down.

I hardly know where to start. We’d come to see Mandy as a double-up as the notes on her file described how she’d been hearing evil voices telling her to tear herself and other people up.
‘But don’t worry. A and E did a risk assessment,’ said the co-ordinator. ‘No history of violence, and they don’t think this was a psychotic episode, as such.’
‘As such?’
‘No. More to do with alcohol withdrawal. So doubling up should cover it.’

I’ve never really understood the doubling-up rule. The way I see it, it doesn’t matter how many people you send in, someone’s going to get hurt. If anything, having other people with you only acts as a distraction. Although it does make me think of that joke about the two rangers walking in the forest, talking about the danger from grizzly bears. ‘Because they run pretty fast, you know.’ ‘Yeah?’ says the other. ‘Well I don’t have to run faster than a grizzly bear, Chuck. I just have to run faster than you.’
But I suppose it means there’ll be a witness

The other thing frustrating thing about this particular call is that Mandy goes out. A lot, according to reports. She gets drunk, then spends her time wandering the corridors of the block shouting and causing trouble. There’s an on-going spat with an ex-boyfriend who has recently moved in with another woman on fourteenth. And any number of substance abusers scattered through the block mixing things up – socially as well as chemically. All in all it sounds like a recipe for chaos, and not something that’s going to lend itself to regular, well-apportioned community care. At a time of severe underfunding, it seems crazy to throw resources at a patient who has the capacity to decide whether they drink or eat or take drugs or not. It’s a lifestyle choice – however severe that choice works itself out in practice.

But our community health team doesn’t have the latitude or leverage to protest. The referrals come in, we go out.

The brief is to establish regular contact with Mandy. To get carers going in every day to encourage her to eat and get her used to some regularity in her life.
‘It’s only until a more regular provider can pick up’ says the Co-ordinator.

‘I’m sorry I wasn’t in earlier,’ say Mandy. ‘I had to go to the doctor’s.’
‘Oh? How did you get there?’
‘Taxi,’ she says. ‘Well they’re not going to come here, are they?’

stepping on a crack

We’ve been told to double-up for this one, so Sasha is sitting in her car outside the hostel, waiting.
‘S’up’ she says, winding down the window.
‘Any sign?’
‘Nope’
‘They said he left the ward by taxi an hour ago.’
Sasha shrugs and puts her phone in her pocket.
‘Well I don’t know what route the taxi took because no-one’s been in or out since I’ve been here,’ she says. ‘and I’ve been here like forever. A proper stakeout. Wha’d’you suppose is in that pan?’
She nods and I turn to look: an orange saucepan on a window ledge outside the building.
‘Dunno. Maybe it caught fire. Why? You can’t be hungry.’
‘Hungry? I’ve been gnawing the steering wheel.’
‘That’s the Christmas effect. Stretches everything.’
‘Tell me about it. I’ve just been googling gastric bands.’
I yawn, look up and down the street.
‘Maybe he got dropped off just before you came, Sash.’
‘All right. I suppose we oughta knock, then.’
She squeezes out of the car, hauls her bags from the boot, and we both go up the stoop to the front door. There’s a carrier bag of empty jam jars on the top step with a note tied to the top.
For Janice.
‘I think they mean Jamice’ says Sasha, pushing the intercom. A dialling tone – then a crackly voice from some remote location.
Scheme manager mouths Sasha, then leans in to the intercom.
‘Hello. It’s the nurses from the hospital. Come to see Frankie.’
The voice says something we can’t understand. A pause, then the door buzzes and I shoulder it open. There’s another, inner security door – and just as I realise we need  buzzing through that, too, the intercom rings off.
Sasha frowns.
‘You’re gonna have to be quicker than that, Jimmy boy’ she says, then goes back out onto the stoop to push the button again. Another wait. The intercom crackles again, but this time the inner door clicks without any words being said.
‘You’ve done this before,’ says Sasha.
What? says the voice.
‘I said we’re in now, thanks very much.’

The lobby has the beaten, low-lit and musty atmosphere of homeless shelters the world over. Some of the doors have numbers, some of them just the ghosts of numbers. Many of them have been kicked-in and repaired, painted and repainted so many times the panels and joints of the wood have a gloopy, approximate look.
Sasha knocks on Frankie’s door. There’s no reply.
‘Did you ring his mobile?’
‘It went to voicemail.’
‘Try again.’
We both hear it ringing from inside the room.
‘So he’s either ignoring us, gone out again and left his phone, or he’s lying on the floor. Either way we’re going to have to do something.’
‘Let’s see if the scheme manager has a key.’
Sasha goes back to the intercom to explain the situation; I put a bag down to stop the inner door closing again, then go back to the steps beside Frankie’s room and knock a few more times, putting my ear to the door to see if I can hear anyone moving.
‘He’ll be over in five minutes,’ says Sasha, coming back. ‘Anything?’
‘Nah. I don’t think he’s in.’

We wait for the scheme manager.
There’s a door marked Private just behind Sasha.
‘What d’you think’s through there?’
‘I dunno. Wonderland.’
Sasha checks her phone again.
‘What are you looking up now?’
‘Places to eat.’

Even though he sounded miles away on the intercom, the scheme manager is with us in five minutes, exactly as he said. Graham completely fills the hallway, so tall and powerfully built I wouldn’t be surprised to hear that his DNA was ten percent viking and fifteen oak.
‘He’ll be in the hospital,’ he says, pulling an enormous fob of keys from his parka pocket and squeezing between us to get to the door.
‘But he’s only just come out!’
Graham looks at me and smiles.
‘I’m guessing you haven’t met Frankie before?’
‘No.’
Graham presses his lips and shakes his head.
‘It’s always the same. They say medically ready for discharge, Frankie hears it as medically ready for drinking. He’ll have got the taxi driver to drop him at the nearest off-licence.’
Graham knocks on the door, calls out, then puts one of his keys in the lock and lets us in.
‘See?’ he says. ‘Empty.’

The room is as squalid as you’d expect. A scattering of filthy clothes, food cartons, random stuff. The bed is rucked up, seamy – bloody, even, the pillows.
‘He fell over and whacked his head,’ says Graham. ‘That’s why he went in this time.’
Frankie’s phone is on the table. Graham picks it up and balances it in his hand like an urban tracker able to tell where the owner was, what they were thinking, where they were heading, simply by the weight.
‘He must’ve come by to pick up some money and left his phone,’ he says, then carefully puts it down again.
‘We’ll follow it up, reschedule and let you know,’ says Sasha.
‘Thanks,’ says Graham. ‘You know – Frankie’s the sweetest guy. Everyone’s done their best, but it’s hopeless, really. He had everything. Great job. Pillar of the community. But something happened somewhere along the line and he drifted off track. Who knows? Whatever it was it’s turned him into the world’s slowest suicide. Anyway! There you are! Thanks for dropping by! And a Happy New Year…!’

He shows us out and waves when we turn to look.

At the bottom of the stoop we pause to let a young family go by: a bearded guy in a red check shirt and Timberland boots, having an earnest discussion on the phone whilst he pushes a baby in a pram, and a tiny boy carefully skips along the pavement beside him.

‘Poor Frankie,’ says Sasha as we watch them. ‘Maybe that was it. Maybe he stepped on a crack.’