life in the bowl

There’s never a good time to have a difficult conversation, but I have to say, despite the Covid measures, the office is as busy as I’ve seen it. I have to scrunch up my shoulders and stick a finger in my ear to have a chance of following what the man is saying to me on the phone.
‘Sorry. Could you repeat that?’
‘I said I’m putting you on speaker.’
‘Oh. Okay.’
‘There!’ he says.
‘Hello!’ says a woman’s voice. ‘Hello?’
I flash an irritated look around me.
Social distancing has only made the noise level worse, because although there are half the number of people you’d usually get at the end of a busy afternoon, everyone’s talking twice as loud to make up for it. And to compensate for the loss of half the desk space, people are improvising by putting their laptops on the tops of the low shelves that mark out the various sections. So in the end, it feels and sounds as if I’m completely surrounded, and the place is as hectic as ever, even though the numbers are reduced and the two metre rule is – more or less – being observed. A gang of people is standing close to my desk, laughing and screaming at something Artie just said. I can see that Artie has cut his hair over the weekend. He’s shaved the sides close but left a wild tuft on top, pulled up into a bunch like the leaves on a knitted pineapple. I guess it’s his hair they’re laughing about because when he whips off the grips and shakes the curls out, they all jump back and scream.
‘Sorry?’ I say, leaning harder into the phone. ‘It’s a bad line…’
‘I said it can’t go on like this.’
‘I know it’s difficult,’ I say, scrolling through the notes on screen. ‘I’m just having a quick look at some of the things our carers and clinicians have said so far…’
‘Difficult?’ says the woman in the background. ‘That’s the understatement of the century. We get calls, all the time, day and night. Mum’s done this. Mum’s done that. Mum’s so worried she’s taken to her bed. I can’t keep going over there. There is a limit. I’ve got my own health to worry about. And Stan is at breaking point. He can’t be at work and sort his parents out. I mean – it’s not as if this was a surprise to anyone. Not to anyone who knows the situation. I told them at the hospital, I said to them…’
It’s been a long and tiring day. It also doesn’t help that both the man and the woman talk very quickly and musically, their voices high up in their noses, blending into each other, overlapping, echoing around whatever room they’re in (the bathroom? a swimming pool?), until it starts to feel as if two bumblebees have popped into my head through my right ear, and are turning figures of eight behind my eyes. I have to give myself a little shake to stay on track.
‘So – let me see if I’ve got this right,’ I say, straightening in the chair. ‘Your mum has been discharged from hospital. Your dad isn’t coping. You think they need more help.’
‘You make it sound easy,’ says the man.
‘Thank you.’
‘I can assure you it isn’t.’
Artie looks over at me, points at his hair, then scrunches up his face and makes the perfect sign with his fingers.
‘Are you still there?’ says the man.
‘Has he hung up?’ says the woman.
‘No, no. I’m still here. I’m just getting the number of the social workers for you…’

two from the queue

Maybe in the future they’ll have an AI coordinator. Something with a wipe-clean face and a decent range of expressions. Something that can reply to an email, accept a referral, schedule a visit, settle an argument, make a clinical decision, take a note, make an amendment, triage a patient, liaise with a pharmacist, sort out an IT problem and laugh sympathetically at the struggles of a new member of staff – whilst at the same time keeping tabs on the thirty or so patient visits that are happening at any given moment. Until they do, though, they’re stuck with us.

Coordinating makes you crazy. Uncoordinated. Or, if not that, exactly, more hyper-coordinated, so that everything you do, even the little things, are done so intensely and with such purpose, you feel a little shaky by lunchtime – something which all the coffee you drink does nothing to ease.

You’re besieged by nurses and therapists, managers and carers, cleaners and admin staff, a constant coming and going, everyone wanting something, from a shift swap to an update to a pencil sharpener. I’m so conscious of the noise levels I’ve toyed with the idea of wearing a Daft Punk-style helmet – maybe with a light on the top that’ll flash when I’m available. I feel sorry for whoever it is I happen to be speaking to on the phone. They must think I’m calling from a bus station or a call centre. It can’t sound good.

There are some perks, though. Limitless coffee is one. The buzz of getting things in order is another. But one of the best are the random conversations you overhear when people are waiting to handover.

For example:

A: I went on that dating app you told me about.
B: Yeah? How d’you get on?
A: Alright. I struggled a bit with my profile. I thought I sounded a bit boring, so when it said hobbies I put chess.
B: Chess?
A: Yeah. Why?
B: Can you even play chess?
A: No.
B: Aren’t you worried you’ll get found out?
A: We’re hardly likely to be playing chess on our first date, are we? Unless they’re a complete perv.
B: But what if they ask you about it?
A: I’ll just say I like to play it now and again and that’s it.
B: But what if they ask you stuff?
A: Like what?
B: I don’t know. Who your favourite player is.
A: (laughs) They won’t.
B: Don’t you think it might put them off?
A: I’ve already had two dates.
B: Two?
A: Two.
B: They must be desperate.
A: Thanks a lot.

And another:

A: I was at the doctor’s the other day and there’s this kid with his hoodie up standing in front of me in the queue, shuffling about. And I think to myself – hang on a minute, that’s Tiffany’s youngest, Brandon. So I tap him on the shoulder, and he turns round, and fuck me, it was! So I says to him “What are you doing here, Brandon?” – but then I think – No! Noooo no no! That’s naughty. I can’t be asking him that. I mean, he might go and tell me, and that’d be awkward. For both of us. I mean – I’m best mates with Tiffany and I might struggle not to spill the beans. But do you know what he says? He says “I’m too embarrassed”. So I say “Well you gotta tell me now.” And he goes: “No. You’ll just think I’m a dullard.”
B: A dullard?
A: A dullard. That’s what he says. A dullard. I didn’t even know what it meant. I thought it was a kind of duck.
B: What teenage boy uses a word like dullard?
A: A Brandon-type boy, obviously Shell. Anyway, I say to him: “Whatever it is I won’t think any the worse of you. Promise.” So he says: ‘I’ve got a fingernail stuck in my throat”.
B: A fingernail?
A: He bites his nails and swallows it. And a bit got stuck in his throat.
B: Urgh! Who bites their nails and swallows it? Gack!
A: Yeah? Well – sorry to ruin your world, Shell, but a lot of people do. And not everyone who picks their nose flicks it, neither.

buy one get one free

The new database was live, and the office was crammed with people – nurses, nursing co-ordinators, therapists of one sort or another, health care assistants, admin staff, pharmacists, and running around and over them all, a team of floor-walkers, problem solving, straightening things out, or trying to, like a team of super-motivated, superintendent, super-capable ants.

It felt good to get out.

* * *

Mr and Mrs Carter live in a cold little house at the bottom of a steep flight of concrete steps. Mrs Carter opens the door. A tall, grey, anxious woman in tracksuit bottoms and baggy black jumper, she greets me neutrally, as if I’m just the last in a long line of Things That Will Go On Happening.

She turns to walk unsteadily back into the bare sitting room, taking her seat by the heater that has just one bar on.
‘Cold today, isn’t it?’ I say, self-consciously setting up my laptop. ‘By the way. Apologies in advance. We’re using these things today. It’s all pretty new.’
‘Oh?’ she says.
‘God knows if I’ll get it right.’
‘Do your best,’ she says, folding her arms. ‘You can’t do more.’
‘No. That’s good advice. You can worry about these things too much.’
‘Yes,’ she says.

Mr Carter bursts through the door. He’s as tall and grey as his wife, but much more energised, with wavy white hair bursting from under his cap. He has one blue eye and one that’s completely filmed over, which intensifies his blustery bonhomie, somehow, and makes him look like some wild, superannuated robot just back from shopping.

‘Nearly fell over running for the bus,’ he says, dumping the bags, tearing off his cap and throwing it like a frisbee off into the corner. ‘That’ll be the next thing. There’ll be the two of us on your list. Buy one get one free.’

He glares and gapes at me, then strides over to the heater.
‘Let’s have this up,’ he says. ‘We’ll freeze otherwise.’
‘Thanks,’ I say, then tap enter to start the examination.
‘Fancy…’ says Mr Carter, nodding at the laptop, then throwing himself down onto the sofa next to me and pushing his fingers back through his hair. ‘The things you have these days.’
But I’m not sure if I’m on the right screen or not, and for a second I’m tempted to pick it up and throw it into the corner like Mr Carter’s cap.
‘Anyway,’ I say, turning to his wife. ‘Ignore all that. The most important thing is – how are you?’

hive mind

Maybe it would help if we dressed like bees.

A little history.

There’s a big reorganisation, a consolidation of three or four front-line community services that pretty well do the same thing. The reorganisation is aimed at reducing duplication, focusing resources, rationalising cover – and no-one can argue with that. Too many times we’re going out to patients and finding another agency already there, doing the same thing. Or, more worryingly, that a patient hasn’t got the help they need because of a glitch in the lines of communication. Although management knows that after consolidation the caseload will increase, the pros will outweigh the cons, the system will be tightened, efficiencies made, money saved, standards raised.

So far, so good. The pros are strong enough and sensible enough to sign up to.

But then the cons start to huddle-in as the consolidation plays out, and it’s more and more difficult to maintain enthusiasm.

There’s a lag in the provision of the IT needed to back the enlarged caseload. Extemporary changes are made to the existing systems, last-minute, white-knuckle affairs. Spreadsheets metastasise. There are queues for working computers, and the ones that work are noticeably slower.

And then there are the folders. In the middle of the office, three large cabinets of them, cluttered-up floor to ceiling with all those patients currently – and quite literally – on the books. A colour-coded, ragged-spined, wretchedly-administrative version of the Tower of Babel. A Wailing Wall of folders.

‘We should go full Victorian,’ says one of the lead nurses. ‘We should have ledgers up on high desks and write with quills. Have fireplaces burning coal.’ She sighs and folds her arms, waiting for the computer to stop updating. ‘Tall hats and moustaches.’

But beyond the IT deficit and the burgeoning folder problem, the most immediate and obvious result of The Great Consolidation is the overcrowding.

An office that was designed for the comfort of a dozen, an office that could, perhaps, at a pinch, handle twice that, now has to accommodate, at the busiest times of the day, upwards of forty. Plus guests. Plus cleaners.

The office runs from eight till eight. The busiest times are from half seven when the early shift arrives; midday when there’s a crossover, and then three o’clock when everyone heads back for handover. At those three times the office is like the floor of the stock exchange, or worse, a giant beehive, with the centre of it being the folder shelves, that great, comb-like structure containing all the honey – rich in patient intelligence, dripping with detail. And it’s these giant combs of information that the nursing staff principally serve, their arms filled with sheets of paper, correspondences, referrals, new folders (of course); doing their best not to crash into each other as they manoeuvre through the runways and cluttered spaces, turning round, feinting to one side or the other, hurrying this way and that, stopping, excusing-me-ing, laughing, gossiping, carrying on in the way that bee people do when they’re pushed for time and harassed and stressed and making the best of an impossible situation.

‘CAN WE HAVE A LITTLE QUIET IN HERE PLEASE?’ shouts the bee pharmacist, one pad clamped over the phone. ‘I CAN’T HEAR MYSELF THINK’

It would be satisfying and instructive at these busy times to lift the roof of the office clean away, and peer in for a moment, and watch with detached fascination the funny little comings and goings. Is that a dance they’re doing? Is that how they know where the patients are? Maybe after a time, you might be tempted to lean in with your puffer of gas, and smoke them all senseless – harmlessly, of course, just long enough to take out the racks of folders, and put them in a spinner, and extract the gorgeous, lovingly-collected intelligence.

‘Mmm! That’s amazing!’ you might say, admiring what you’d collected, dragging a finger through the observations, the progress notes, the summaries and the charts. ‘You could really make something out of that!’ And then gently replacing the shelving, and sliding the roof back into place, you might sit for awhile on the opposite roof, and breathe quietly, and listen to all the buzzing.