in plain sight

The operations centre – a thriller movie cliche. That tickety white writing at the bottom of the frame: Langley, Fairfax: 15:00. Or something. An office so ridiculously busy you can almost hear the echo of the clapper board and the director shouting ACTION!. Zoom in to a stressy operative hunched in front of a bank of computer screens, frowning, pressing the headset closer to their ear. ‘I’m sorry – can you repeat that?’ While a tense boss strides over and leans in. ‘Get me Moscow!’ or something. ‘I need eyes on the ground, the air. Goddamn it I want eyes on the eyes!’ And so on.

I’m talking it up. But the fact is, a large part of helping out on the clinical coordination desk is troubleshooting problems, however they present. A patient wanting to know what happened to a visit, a doctor with feedback on a treatment outcome, a clinician needing support, or numbers, or access codes, or availability for this, that and whatever else. A hundred requests, often at the same time, whilst a queue forms behind you of people wanting to discuss an earlier decision, or request clarification, or get the latest statistics, or hand you the latest flow diagram…

It’s a hectic environment – sometimes unbearably so – but once you’re set up at the desk, with everything open on the screen to give you what you need, your pad and pens and highlighters and snacks and three different mobile phones all laid out on charge, you start to feel like you can cope with anything, and find anything out, and coordinate the absolute shit out of the place. And now that I’ve found a headset to use with the phone, I feel even more prepared, because although the others laugh at me and think I’m overdoing it, still, I’m the one without the terrible crick in my neck from cradling the phone whilst I type, and I’m the one with my hands free to gesticulate if I think it’ll help. Plus I think it looks cool, so – whatever.

‘She’s gone, Jimmy.’
‘Gone? What d’ya mean, gone?’
‘She just disappeared. I rang the intercom. Jackie answered. She said come on up. She buzzed the buzzer. I went up the stairs. Five flights. No lift. Have you been there?’
‘No. But I’ve heard all about it.’
‘Five flights. Narrow – and so steep. It was like climbing a tree. So I got to the top, puffing and blowing. The door was open. I said Hello? Jackie? I went in. And she wasn’t there.’
‘Have you had a good look around?’
‘A good look around? Yes – of course I had a good look around. What do you think? Anyway – it is not a big flat, Jimmy. It is very small, like a bedsit really. Just one big room, a small bathroom, a tiny kitchen, and that is it. A little nest at the top of the tree. I even looked in the cupboards. Nothing. No sign. No Jackie.’
‘I don’t understand.’
‘So what should I do? I rang her next of kin and they could not say. She doesn’t really go out. And she doesn’t have a mobile phone, so it’s not like I can ring her.’
‘Let’s get this straight, Ada. You called Jackie on the intercom. She answered and let you in the main door. You walked up the stairs, five flights. Her flat door was open. She wasn’t in the room.’
‘Correct. And she’s very frail and elderly. It’s not like she could run down before me, or climb out a back window or anything like that.’
‘Maybe she went into another flat?’
‘She has the top flat. So she’d have to come down at least one flight to go to the next one. But why would she do that if she knew I was coming up? It is all very peculiar.’
‘The only other thing I can think of is that you didn’t actually ring Jackie’s flat number.’
‘Excuse me?’
‘Maybe you thought you rang her number but rang someone else’s by mistake. They answered – sounded a bit like her – they buzzed you in regardless. Maybe Jackie went out ages ago and left her door open.’
‘Hmm. Maybe. But I’ve been here before and it definitely sounded like her.’
‘Those intercoms can be deceptive.’
‘I’m not sure.’
‘Can you do me a favour, Ada?’
‘Of course. Anything. I’m here now.’
‘Can you have one last look around the flat. Even if it means looking under the bed.’
‘Under the bed? Why would she be under the bed, Jimmy? She is not a cat.’
‘No – but – stranger things have happened.’
‘If they have I’ve never heard of them. Under the bed?’
She says something I don’t catch, and makes a clucking noise.
‘Just have one last, really good look around the place, Ada. To reassure ourselves she’s absolutely and completely definitely not in the flat.’
‘Well… okay. But I tell you now for one thing – that woman is not here.’

Ada puts her phone down somewhere but leaves the line open. I listen to her as she harrumphs about the place, calling out Jackie’s name once or twice in a sing-song way, just exactly as if she’s trying to find a cat. After a minute or two I hear a startled ‘Oh!’ then a ‘Hello, Jackie! Just a minute, please…’ Then the sound of her approaching the phone, picking it up, and ‘I have found the patient, Jimmy.’
‘Where was she?’
‘Lying on the bed.’
‘Great!’ I say. ‘That’s a relief!’
‘Thank you for your help,’ says Ada. ‘Talk to you later!’ And she rings off.

I pull the headphones off my ears and stretch back in the chair.
Michaela sits down opposite me.
‘You’ve seen Jackie before, haven’t you?’ I ask her.
‘The old woman who lives in the attic? Yes, a couple of times. Why?’
‘Does she wear clothes that exactly match her bed linen?’
‘Does she… what?’
‘Nothing … it’s just …’
The phone rings again.
‘I’ll tell you in a minute,’ I say, and press pick-up.

pugs!

If you work on the coordination desk long enough you’ll feel yourself change.

Nothing dramatic or immediate, but imperceptibly, stealthily. It’s a hazard of the job, the frantic business of it, tapping away at the computer keys, answering two phones at once, taking questions from colleagues who wait in a restive line like shoppers at the Deli counter. A function of the distracted firing of your brain cells, the agitated beating of your heart, the immobility of your body in the chair. All these things will take hold, come together and warp you at a genetic level, cannoning your atoms into novel patterns like a drunken God with a billiard cue until – too late – you realise you ARE the phone, you have BECOME the computer, you have ABSORBED the notepad. You’ll only notice at the end of the day, when you go to stretch and your arm snaps in half because it’s changed into a pencil. Or you roll your neck to ease the cramp and your head logs off. Or you go to stand up but you can’t because your vasculature is now the furniture and your spinal cord has extended through the floor tiles and uploaded you to the network.

That’s the down side.

The upside is that eventually you’ll find yourself in synch with the office. You’ll be tuned-in to everything happening around you without even trying. You’ll be working the desk like a dreaming, caffeine-crazed spider, a little bored maybe, a little restless, your compound eyes flickering with the light of the database, whilst you unconsciously monitor the action around you by the vibrations you feel through your feet.

Which is a complicated way of saying I was aware Karen was on the phone before I really knew it.

Sophie was talking to her. Sophie is one of the administrators. She’s on the frontline of the operation, taking calls, giving information, directions, advice, or deciding where to redirect – which more often than not means patching them through to the coordinators. Sophie is great at her job. She’s warm and friendly, however long the day or trying the circumstances. I love the way she answers each call with the same intonation – saying the company name with a flourish like she was throwing a fancy tablecloth over a workbench. But then her tone changes immediately, coming down a notch, and within seconds she’s speaking to the caller as if she was gossiping with a favourite aunt.

Only this time, she wasn’t.

Sometimes even Sophie struggles to connect with the caller – especially if the caller is Karen.

Karen has been referred to us many times before. She’s difficult, in the way that Medusa was difficult, except in Karen’s case it’s not snakes but pugs. She lives in a state of constant war with everyone and everything, storming through the world with a half dozen pugs clutched to her chest, their bug eyes an expression of the stress she’s under, or the strength of her grip, or both.

I zone into the conversation half way through.

‘…Karen? Karen? I’m afraid you’ll have to put the dogs in another room or something because I can’t hear a word you’re saying…. Karen? Karen? Honestly – it’s impossible. Put the pugs in another room, Karen. Yes. That’s right. Another room. And shut the door… I’m sure they’ll be fine… it’s just for a minute, Karen, so I can understand what the problem is. Lovely. Thank you. Could you start again, please? …. Okay… Okay…. So you need help of some kind, is that right? A nurse. Okay. Well – I see from the notes here that a nurse came round to see you about an hour ago and you didn’t let them in… Is that right, Karen? …. Okay…. Okay…. Well, as I’m sure you’ll appreciate, it’s difficult for us to specify male or female… No, Karen. They’re all nurses. They’ve taken the same qualification…. It’s very difficult to do that, Karen. We can try, but it may mean a delay in getting you the help… Yes. I understand that, Karen…. I’m sorry you feel that, Karen…. but they probably only knocked like the police because they didn’t know whether you’d heard them or not… Well, because of the dogs barking….Yes, well, I’m sorry your dogs were upset by that… I’m sure they do… Karen? If you want to put in a complaint you’re more than welcome to do so. But if I could just… if I could just… No, that’s not what I’m saying, Karen…. if I could just…Have you let the dogs back in, Karen?..Karen…?’

Sophie holds the phone away from her ear, catches my eye, shakes her head, plunges back in.

‘Let me put you through to Jim,’ she says. ‘Maybe he can help…’

She punches in my extension.

‘Karen for you,’ she says when I pick up. ‘Good luck.’

And when my phone connects, it’s like a bone being tossed in the middle of a dog fight.

‘Karen? Karen…?’

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.
(pause)
B: Don’t you think it might put them off?
A: I’ve already had two dates.
B: Two?
A: Two.
(pause)
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.