large caliber

‘Shall I take my shoes off?’
‘Oh no!’ says Rita. ‘This is a real home – not a show home!’
I’m conscious that my shoes are sopping wet, though, so I slip them off anyway.
‘I do it at home’ I say. ‘I’d feel bad otherwise.’
‘This is a real home, not a show home!’ she says, repeating herself – whether because it’s a catchphrase of hers, or because she likes the sound of it, I’m not sure.
‘Follow me!’ she says, and leads me through the house.
It certainly has the feel of a show home. Or even a gallery, given the number of paintings of stags on snowy crags and jugged hares lying among bunches of grapes, all in heavy gilt frames. Ernest, Rita’s husband, sits in a chair at the far end of the house, like a decrepit attendant who dozed through his lunch break and on into his nineties.
‘Darling? There’s a nurse to see you!’ says Rita. She waves me over to him, then lowers herself very correctly, debutante-style, into a Louis Quinze chair, her legs angled to the right, her hands folded in her lap.
‘What happened to your shoes?’ says Ernie, peering at me over his glasses.
‘They were soaking wet. I didn’t want to make a mess on your carpet.’
‘I said to him, darling,’ says Rita. ‘I said to him: This is a real home. Not a show home!’
‘Hear that?’ he says. ‘So now you know.’

* * *

All Ernest’s observations are within normal range – his blood pressure, temperature, heart rate and so on..
‘What were you expecting?’ he says. ‘I’m perfectly fine. It’s this damned back.’
‘Let the gentleman do his job, darling,’ says Rita, absentmindedly playing with her wedding ring, slipping it off, then on, then off again. ‘He used to be a sniper, you know. In the war, of course,’ she adds, hurriedly, to clear up any misunderstanding.
‘A sniper?’
‘What of it?’ he snaps.
‘No. Nothing. It sounds fascinating.’
‘Hmm,’ he says, and watches me closely as I fill out his obs chart. To cover the silence – and to find out more about his sniper years – I dig deep for some personal story I could use.
‘I had a go at skeet shooting once,’ I say. ‘It was a work’s outing. I really liked it.’
‘Skeet shooting?’
‘Yes. Clay pigeons.’
‘I know what skeet shooting is.’
‘It was really good! That bit where they chuck the clays along the ground, and they bounce around all over the place. That was fun. You know. Picking them off.’
‘Fun?’ says Ernest, horrified. ‘Fun? If by fun you mean waving your weapon around like a lunatic, blasting in the general direction of where you think something’s going to end up, well, then, perhaps. But I’m not talking about some random spread of pellets. I’m talking about the precise placing of a single, large caliber bullet. I’m talking about controlling one’s breathing, slowing one’s pulse. Taking a clean shot.’
And he glares at me over his glasses again, eyebrows quivering, drawing a bead.
‘It’s my second marriage’ says Rita. ‘Would you like a cup of tea?’

bonnets vs aliens

Like a country that declares war on its neighbours over a mountain ridge, Mrs Alderman has gone to war over her back.

It’s been the cause of a great many problems and pain for her over the years, and lots of clinicians of one sort or another have been involved. But there are some degenerative diseases that can’t be cured with medication or fixed with surgery, and the best you can do is try to ease the symptoms and find a way of organising your life in a more accommodating way. Unfortunately, Mrs Alderman’s response has been to declare war on everyone who has tried to help. Top of her list are the orthopods, who – according to Mrs Alderman – are a bunch of clowns with chainsaws. The orthopods are followed by everyone else who works in the hospital, Consultant to Cleaner, then the ambulance service, Community health teams, doctors, their reception staff, and really anyone who happens to be driving past, and then her neighbours, of course, and most of all, her family.

Her grandson Joey has been staying with her a few days since this latest discharge from hospital. His main contribution has been to restock the fridge freezer with ready meals. Much further than that he’s unwilling to go, and it’s hard to blame him, really. The flat is an absolute mess, and even if you brought in a team to straighten the place out, Mrs Alderman would have it back in its current state before they’d posed for photos and shut the door behind them.

This sprawling sense of chaos and complaint seems to attach itself to any contact with Mrs Alderman. I’d been sent in to conduct the initial assessment, which is essentially a fact-finding mission, to see how she is and what she needs from us. We’d had a frank conversation about emergency care support, what she could and couldn’t do for herself. She’d agreed that one care call in the morning might be helpful to get her washed and dressed; everything else – taking her medication, putting a ready meal in the microwave – she could do for herself. She could get out the chair by herself and take her four-wheeled walker out of the flat, down the corridor and back, so she was by no means immobile. And it was important to take regular exercise, however limited.

What happens next is that Mrs Alderman is on the phone that evening complaining that the carers hadn’t shown up, that the morning carer had done nothing but stand in front of a photograph of a dog she used to own called Rusty saying how nice ginger dogs were, for fack’s sake, and then pulled off her support stockings and took them down to the laundry room.

‘They’re in the dryer,’ she says.
‘Who put them in the dryer for you?’
‘How the fack would I know?’
‘Can’t Joey fetch them up?’
‘Why should he? He’s seventeen! And anyway, even if he did he can’t put them on for me, can he? And I can’t. Not with my back. I thought you were supposed to be facking helping…’

The carer isn’t around to ask about any of this. My suspicion is that Mrs Alderman removed her own stockings and took them to the laundry room herself, but the Coordinator is worried.

‘It might be easiest if you just go there tonight and sort her out,’ she says. ‘And try to clarify the situation whilst you’re there.’

* * *

There’s just one person in the laundry room, an ancient woman bent over a broken plastic trug, busy shovelling the contents into a machine. She looks up when I come in, supporting herself on one arm so precariously she looks in imminent danger of pitching head-first into the washing machine.
‘Hello,’ I say. ‘I’m Jim, from the community health team at the hospital. I’ve just come to pick up Mrs Alderman’s washing and take it up to her. I think she left it in the dryer.’
The woman straightens.
‘Oh! She’s got you running around now, has she?’
I smile and shrug.
‘That’s her lot, there,’ she says, nodding at another plastic trug, piled up with dressing gowns and throws and things and two blue support stockings artfully draped on top.
‘She puts too much in’ says the woman, tightening the scarf round her head, then leaning back in to her load.

* * *

When I knock and struggle through into Mrs Alderman’s flat, the TV is on full volume. She’s watching a film – marines fighting alien invaders or something. A helicopter gets blown to bits and there’s a close up of Aaron Eckhart looking worried.
‘Put it down there,’ shouts Mrs Alderman to me, as if we were under fire, too, pointing the remote at an undifferentiated heap of crap in the middle of the room.
‘Fack me, I don’t know,’ she says, muting the TV. ‘One minute it’s Sense and Sensibility, the next it’s facking aliens.’

the stone queen

There are warning signs tied to every lamppost: Road resurfacing. No parking. Tow-away zone. The silhouette of a truck dragging off a car, and a date scrawled in the space beneath. The date is tomorrow, though, so I figure I’ll probably be good to park here today. I’m prepared to take the risk. If I had to look for a parking space anywhere else I’d end up have to walk miles, and I’m behind on my visits as it is. I put my Parking Exemption ticket on the dashboard, grab my stuff and walk up the path to number 18.

Mina’s daughter, Sarah opens the door. She smiles bravely but looks exhausted, a fresh-looking perm accentuating the dark lines under her eyes, as if the energy it took to highlight and curl has used up whatever reserves she had left.

‘Mum’s upstairs,’ she says. ‘She hasn’t left the flat in a year or more – well, except for appointments.’

Despite the bright sunshine outside – or maybe because of it – the room is muted and still. There’s a large aquarium bubbling away against one wall, stunned fish drifting in and out of focus. The aquarium is so dominating, it seems to extend and occupy more than its own space, especially as the walls and the carpet are mottled green and blue, and all the furniture, too, soft and plump, making it feel like a state room on the Titanic, everything swollen with coral blooms. Mina is sitting in a scallop-backed armchair in the window, Queen of this Undersea World, except her robe of fish-scales is actually a fluffy blue dressing gown, and her trident is a walking stick.

I pull up a lobster, and ask how she’s feeling today.

She turns her sad eyes down on me, and with her knotty fingers draped over the handle of her stick, she sings me the sad, siren song of her back. A soft, sinking kind of song, as lulling as the bubbles. A song of osteoporosis, rheumatoid arthritis, COPD, heart failure, and diverticulitis. Of degenerative changes to lumbar vertebrae that can never be corrected. Certainly not by surgery; she wouldn’t survive the operation. All they can do is control her pain with medication. But she’s sensitive to just about everything, and they’re running out of ideas. She has all the equipment she needs. She knows the maisonette is inappropriate, as she can’t easily manage the stairs, but she’s lived there so long she couldn’t face moving – not that there’s anywhere to move to, bungalows being in such demand.

Sarah is sitting on the opposite chair, kneading her hands as she listens, as if she’s working through it by some invisible mechanism, forcing it to a conclusion. She interrupts when she can: I’ve got my own problems she says. Work. Kids. Everything else.

The questions I manage to ask have all been asked before. Mina deals with them all in turn, scarcely pausing to think, wrapping them up in words, kelp around a propeller.

‘Well – I’m limited to what I can do today,’ I say, shaking myself into action. ‘I’ll do your obs – you know – your blood pressure and so on, just to make sure there’s nothing else going on that might be making things worse, like an infection and so on. Take some blood, too. And then liaise with the GP. How does that sound?’

Mina smiles sadly, then turns her head towards the window.
‘They’re fixing the road tomorrow,’ she says, as I open my bag and set out my things.
‘I saw that! I didn’t know whether it was safe to park or not.’
‘It’s safe,’ she says. ‘I can see your car from here. The little blue one. If anyone goes near it I’ll use my stick and turn them to stone.’

And she taps it, once, on the carpet, to illustrate.

thora’s calvary

‘Do you believe in God?’ says Thora.

I hesitate before I answer – not because I’m afraid of saying I’m an atheist, but more because I know how freighted the question is. Thora is ninety-five, in failing health, her world shrunk to the size of a pressure cushion, a riser-recliner, what light and life the carers bring in, and the occasional family visit. The degenerative changes to her spine are inoperable, as she wouldn’t survive the general anaesthetic. Her pain medication is at maximum stretch, providing temporary relief at best. Thora’s already told me she’s ‘ready to go’, and seems a little bewildered that the days still follow one after the other in an endless line without any prospect of release.

‘Well – it’s not that I don’t believe in God,’ I say, sounding as if I’m hedging my bets. ‘It’s more that I don’t believe in a literal interpretation of the bible – or any religious text, come to that. I think they’re stories people tell themselves to express how they feel about the world and give them a sense of meaning. They’re creation myths, really. Which is fine. But do I think heaven is this sunny place in the clouds with a big, judgy guy handing out justice? I don’t think so. I think all these stories are just a big hangover after we developed consciousness. We’ve kidded ourselves we’re the most important thing on Earth, and we can figure everything out, and we know what’s what, because we learned how to make a hammer and a fire and – I don’t know – a rocket to the moon. So we invent the Gods we think we deserve.’
‘So you don’t believe in God?’
‘Not really, no.’
‘Aren’t you scared you’ll go to hell?’
‘No. I just don’t think it exists. There’s plenty to be scared of here on earth without worrying about a fiery pit.’
‘That’s what you say now.’
I shrug.
She shakes her head and bites her lip. I can tell her back’s troubling her again, but she’s had all her meds, so all I can offer her is a cup of tea.

When I come back she seems a little more settled.

‘Did you see that interview Stephen Fry gave?’ she says, putting the cup down. ‘On some chat show.’
‘Yes. I did see it. A few months back. On YouTube. He made some good points.’
‘He said something about an insect in a baby’s eye. And why would God do that.’
‘Yes. He was pretty emphatic.’
‘What do you think about that, then?’
‘I think he’s right. But I didn’t think he was angry at God. I think he was angry at people who take the bible at face value, in a simplistic, kind of fundamental way. And I don’t think it’s all that helpful, sometimes. Didn’t he say something about the Greeks being better at that sort of thing, because their Gods took into account human frailty? They didn’t try to force God into a corner, to make him this all-seeing, all-loving figure. Because it’s impossible. It just doesn’t square with all the injustice in the world, insects, earthquakes, cancer – you name it.’
‘Back pain?’
‘Definitely back pain.’
‘Well,’ says Thora, picking up her tea. ‘You may have a point. Mind you, I should think God’s got a lot on his plate, what with one thing and another. I’m not surprised I might have slipped his mind.’

the very hungry caterpillar

‘I’m sorry if I was snippy when I answered the door,’ says Marjorie. ‘I thought you’d come to read the meter.’
‘That’s okay. I’d be the same if someone knocked me up first thing on a Sunday. I did try calling you…’
‘Yes. Well. We don’t answer if we don’t know who it is.’

Marjorie is sitting one end of the table, her husband John the other, making me feel less like a clinician and more like a family counsellor. It’s John I’ve come to see, though. He doesn’t seem anywhere near as bad as the referral suggested. In fact I’d go as far as saying he looks perfectly fine, chomping enthusiastically through a small stack of jam toast, with occasional gulps of tea to wash it all down.
‘Ahh!’ he says, setting the mug aside, and then, after picking up another slice of toast and holding it in front of him for a moment with something like a lover’s gaze, begins again. It’s like watching a giant caterpillar methodically working round a leaf – a caterpillar dressed in an Arsenal bobble hat, fleece and jogging bottoms.
‘Mind your fingers’ says Marjorie.
He nods, his eyes closed.
‘He fell off a ladder, you see,’ sighs Marjorie, securing her dressing gown with a resolute tug of the cord. ‘A few years ago now. He didn’t fall that far, but it was down onto the patio, and all the pots. He was pruning the jasmine. I’d told him to wait till I got back so I could foot the bottom. But no – he’s always just carried on regardless. And now look. One leg shorter than the other. He wears an insert in his shoe, but it doesn’t make any difference. And of course, everything else gets thrown out of whack. He’s got permanent back pain.’
John finishes his toast with a sigh, pushes the empty plate forwards and leans back in the chair.
I ask him what he takes for the pain.
‘Paracetamol!’ he says, slapping his tummy. ‘Four times a day.’
‘You shouldn’t be taking so much,’ says Marjorie. ‘It’s not good for you to take it all the time.’
He shrugs.
‘The doctor says it’s okay. If the doctor’s happy, I’m happy.’
‘It’s bad for your liver.’
‘I don’t see what it’s got to do with you,’ says John. ‘Are you a doctor?’
‘Everyone knows paracetamol are bad for you.’
‘Are you a doctor, Marg?’
‘Doctors don’t know everything, John.’
‘I say again – are you a doctor?’
‘I’m not having this discussion.’
‘I’m happy with paracetamol. The doctor’s happy with paracetamol. Let that be an end to it.’
It’s obviously a sore point between them. I try to take a middle position.
‘It’s difficult,’ I say. ‘Chronic pain is different to acute pain. You handle it differently. I mean, if you get a headache, you take something to help with that. But if you have pain all the time, you need to take regular doses to keep yourself on an even keel. If you let the pain get too bad, it’ll take more of something to get you back into the okay zone. The idea is to maintain a good cruising altitude.’
To illustrate, I make a half-hearted rising and falling gesture with the flat of my hand. Marjorie watches me with a slack expression.
‘I haven’t the faintest idea what you’re on about,’ she says.
‘I do’ says John, sucking a glob of jam off his thumb. ‘I do.’