bibi the bird

Melvin is as landed and unfortunate in his armchair as a hippo in the dry season. An affable hippo, though, in a taut, custard yellow, California Dreamin’ t-shirt and grey jogging bottoms, his enormous hands restlessly picking at the padding of the arm rests, as if he’s gauging the right moment to tear them off and throw them.
‘What were you saying?’ he says. ‘I lost the thread.’
He laughs, exposing a few raw and stumpy teeth. If I had a head of cabbage I’d chuck it, watch him crunch it down, waggle his ears.
‘He does that a lot,’ says Bibi, Melvin’s wife. ‘Lose the thread, I mean.’
If Melvin is the hippo in this relationship, Bibi is the little bird that rides on his head. A trim, quick figure, she’s constantly up and down, repositioning cushions, fetching beakers of juice, a towel, a diary, a snack, another beaker of juice. She smiles at me and surreptitiously touches the side of her head, turning the gesture into an innocent scratch of her eyebrow when Melvin unexpectedly glances her way.
‘So what’s the plan, chief?’ says Melvin. ‘What’re you going to do with me? Drag me off to the knackers yard, I ‘spect. I’d make a lot of glue. ’
‘Don’t say that!’ says Bibi, jumping up again to move the stool so he can reposition his feet.
‘Ahh!’ he booms. ‘Thanks Beebs.’

The situation has been a long time coming and it’s hard to know where to start. Diabetes, joint damage, skin infections, kidney and liver issues – the list neatly packaged-up in the phrase comorbidities. Things were difficult enough before his latest fall, but he’s been discharged from hospital with a bandaged foot and the results of an MRI confirming mixed dementia. There’s a lot to think about.
‘Today’s a good day,’ says Bibi. ‘Isn’t it darling?’
‘Every day’s a good day,’ says Melvin.
‘Well,’ says Bibi. ‘Mostly.’

She’s doing her best to cope, but it’s a struggle. She’s already told me about his mood swings, how he’ll be fine one minute and raging the next. There’s a shine to her eyes that’s so brittle I don’t know if she’s ready to sob, scream or laugh out loud.
‘But where are my manners?’ she says. ‘Can I get you anything?’
‘No, no! That’s kind of you but I’m fine, thanks.’
‘Just let me know. It’s no trouble.’

Melvin is sitting in front of a large white blind. The blind has been pulled down to shield him from the midday sun. Now and again the shadow of a seagull glides across the blind, so clearly you can even see the toes of its webbed feet and the way it flicks its head from side to side. Down in the street some workmen have finished lunch. They’re shouting and swearing, starting up the mixer, tapping off bricks for a new wall.
‘Hear that?’ says Melvin. ‘I expect that’s the seagull, building his nest.’
We all laugh.
He clasps his hands across his belly, waggles his ears.

sunset terrace

‘I’m just finishing off my mother’s rectal area but you could come over at a quarter past five if that would be acceptable?’
I check my watch. It’s ten to.
‘Okay. Fine. I’ll see you then, Jeremy.’
‘Lovely, James. Looking forward to seeing you at a quarter past five, then. Goodbye.’
I don’t know what’s more disconcerting – the formal description of the personal care Jeremy’s giving or the way he changed ‘Jim’ to ‘James’. Either way, I’m intrigued to meet him.

The house is in the middle of a long terrace, the only thing marking it out being an atmosphere of general neglect. Nothing too awful; more like a disaffected giant leant in with the eraser end of an enormous pencil and rubbed it out a little. The number is a rusted iron affair, the black paint long since flaked off, hanging on a skew so it’s only possible to make out by taking it in sequence with the numbers on the houses either side. I ring the bell and take a step back. After a long pause Jeremy comes to the door, wiping his hands on some kind of souvenir tea towel.

‘Oh hello, James!’ he says, draping the tea towel over his shoulder and reaching out to shake my hand. His feels icy from the water, soft and broad, too; if I closed my eyes I could imagine I was shaking flippers with a seal.
‘Don’t just stand there!’ he says, flapping me through. ‘You’ll catch your death.’
‘It’s freezing – but at least it’s bright.’
‘Yeees! It’s surprising what you can tolerate with a little light. She’s just through here, James. Excuse the mess.’

The house still follows the original two-up, two-down floor plan – a small front sitting room and back parlour, a tiny kitchen and downstairs toilet, and two rooms upstairs. Jeremy has set his mum’s bed up in the parlour, just about managing to squeeze it in along with a commode and a comfy chair. The front room is for watching TV, and this is where his mother is sitting, wearing a short fur jacket and a beige turban – a little at a slant – fixed at the front with a brooch. Jeremy’s paintings cover the walls: swirling life studies in reds and browns and yellows, so thickly done I imagine he uses both ends of the brush, and then maybe his feet.

I introduce myself to Jeremy’s mother, but although she smiles contentedly she makes no sign that she’s really understood who I am or what I’ve come to do. Jeremy leans in and bellows in his mother’s ear – much more of a shock to me than it is to her – then leans out again.
‘She’s a little hard of hearing,’ he says, gently. ‘Would you like me to make you some tea whilst you take her readings?’

I run through the obs, and I’m pretty much done by the time he brings through two mugs and a beaker for his mum.
‘Everything looks fine,’ I say, looping the stethoscope over my neck and taking the mug.
‘Well that’s a relief.’
‘Yep. I think all we need to do is book some physio to get your mum back up to strength, have someone come in a couple more times to make sure she stays on the level, and maybe have an OT come round to see if there’s any more equipment you might find useful.’
‘I don’t know where it would go,’ says Jeremy. ‘I mean – look at the place. But we’re in your capable hands. We’re really very grateful.’
I write up my notes on the laptop whilst he sits on a stool and watches.
‘I love your paintings,’ I tell him.
‘Thank you!’ he says. ‘I use their old front bedroom as a studio. The light’s much better there, you know. Painting’s my thing. It’s what keeps me sane.’
‘Everybody should definitely have a thing. But how would you say you’re bearing up generally? It must be quite a strain.’
‘Oh. That’s kind of you to ask. It has been hard, that’s for darn sure – but I’m fine. As I say, I have my art.’
‘Do you need any care support?’
‘What would they do? I do it all.’
‘Well – I don’t know. Give you a bit of a break? Maybe you could consider some respite care at some point. You’ve got to look after your health, too.’
He laughs.
‘Me? I’m alright. You have to be, don’t you? I must admit it was hard at first, though. I had no idea what I was letting myself in for. But the rest of the family live abroad and they’ve got their own families so there wasn’t really anyone else. I’ve just had to learn as I went along. And now look at me – nurse, domestic, pharmacist, accountant. Electrician! But like I say. I still have time to paint. And we watch a lot of black and white films together, don’t we mum? We’re going to watch one when you go. A good one. Sunset Boulevard. Mum’s favourite. We’ve seen it I don’t know how many times. Norma Desmond…’
He puts his mug on the floor, jumps up, straightens, widens his eyes, snarls, throws the tea towel over the opposite shoulder and says Ready for my close-up, Mr DeMille.
He holds the pose a few seconds, then sits back down on the bed again and picks up his mug.
‘And – scene!’ he says, taking a sip.

cynthia’s view

Cynthia’s flat is above a laptop repair place on the high street.
‘Shame they don’t do people,’ she says. ‘I could do with some of that.’
It’s about as central as it’s possible to be, though, and handy for the shops, if only Cynthia didn’t have to negotiate a set of stairs so steep they may as well be a ladder.
‘I used to run up and down when I was younger,’ she says. ‘Not any more. Not with these knees. But what can you do? At least they match the rest of me.’
Cynthia has been referred to us for help following a bad chest infection, something she’s prone to after years of respiratory problems. By rights she should probably be in hospital, but she refuses to go.
‘I’m not going in just when Ted’s coming out,’ she says. ‘Who’d look after him?’
They’ve been married sixty years, the last three overshadowed by Ted’s dementia. He was admitted after a fall – ‘the bathroom, not the stairs,’ she says, crossing herself – and other complications. ‘He gets so distressed. That’s the hardest thing. Most of the time when he’s home he’s not too bad. He goes downstairs to have a smoke in the street. I have to keep watch out the window to make sure he doesn’t wander off, but he’s only done it a couple of times, and people know him round here. I get so exhausted the end of the day I hardly know what to do with myself. And I know what everyone thinks, the rest of the family, the doctor and everyone. They all think I should just put him in a home. But I couldn’t do it to him. He went into one a while back, to give me a break, and when I went to see him he was so upset I just said right, I’m fetching you back home with me and that was that. One day he had in there, and that was one day too many.’
I tell her we can have a look at how much help she’s getting at home. There are always things to be done.
‘That’s kind of you but don’t worry,’ she says. ‘I’m coping alright at the minute. I mean – he gets up at six! The carers don’t show till nine or half past – and by that time I’ve washed and dressed him myself. So they end up looking around for something to do, and I feel guilty I’m wasting their time.’
I tell her it’s something to bear in mind, though.
‘I went to see him yesterday at the hospital,’ she says. ‘You should’ve seen him. He was sitting on the side of the bed with all his bags packed around him. The nurses said he’d been like that for hours. He keeps telling us he’s got to get home because he’s supposed to be looking after his wife.’
She laughs and shakes her head.
‘Honestly! He’s got no idea. But you know what? I think when he completely loses the plot and doesn’t know me or what’s going on, then I might think about putting him in a home. I don’t think we’re quite there yet, though. I suppose you just have to stay strong and take it a day at a time, don’t you? One day at a time. l mean – nothing lasts forever, does it? Hey?’

I’m guessing Cynthia is sitting in the same seat she uses to keep an eye on Ted when he’s down on the pavement, smoking. She stares out of the window now. It’s a bright, busy weekday lunchtime, and the street is pretty crowded – shoppers, school kids, office workers striding so purposefully their lanyards swing from side to side as they head for the fast food places.
‘Busy,’ I say.
‘Yes,’ she says. ‘But it quietens down at night.’

sleep

Arthur is about as cold and severe as it’s possible to be without actually being struck from a block of granite. Tall and broad, a little stooped at the hip, he slowly wheels his wife Pat into the kitchen, parks her at the table, fusses some things on the tray in front of her – a box of tissues, a beaker of cold tea – then sits heavily in the chair opposite.
‘What do you propose to do now?’ he says.
I explain why I’ve come. He listens, frowning, hardly able to meet my eye he’s so cross.
‘How long will it take?’ he says, cutting me off. ‘I’ve got things to do, you know.’
‘I’ll be as quick as I can. I should think about twenty minutes.’
‘Twenty minutes? Couldn’t you make it fifteen? She’s got her feet at one.’
‘I’ll do my best.’
My best is obviously not good enough. Impervious to my attempts to soften him up and win him over, Arthur folds his arms and watches me prepare my things. Every now and again he releases a quantity of air through his nose, like it’s a safety valve easing the pressure in his head.
‘You should come like you arranged,’ he says.
‘Yes. I’m sorry I was delayed. But it’s not that far off. Is it?’
‘You shouldn’t make appointments if you don’t intend to keep them.’
‘I know, I know. It’s just really difficult to judge. Things happen.’
He grimaces.
‘An appointment’s an appointment,’ he says.
‘Absolutely. You’re right. I could always come back later…’
I hope he won’t take me up on that, because then I’ll really fall behind. But, luckily for me, all he does is check his watch and wave me on.
‘So long as you’re quick,’ he says.

Pat, on the other hand, is almost completely inert. Her dementia has made her childlike – or, if not that, exactly, then animated by a disquieted kind of wonder at her own condition, looking at me and Arthur and the room we’re in without any apparent differentiation.
‘I don’t know what good you think any of this will do,’ says Arthur, as I take her obs. ‘The doctor did it all last week.’
‘Things change,’ I say, pulling the stethoscope from my ears and unwrapping the blood pressure cuff. ‘You have to take a few readings over a period of time, so you get a good picture of what’s going on. But in this case, everything seems fine.’
He grunts, sighs, rubs his face, checks his watch again.
‘So that’s that,’ I say, filling in the last of the figures. ‘Now. What about you?’
‘Me?’
‘How are you coping?’
He shrugs.
‘Are you getting the help you need?’
‘What kind of help?’
‘Carers. You know. That kind of thing.’
‘I’m her carer. What would a carer do?’
‘I don’t know. Help get Pat washed and dressed in the morning. Take care of her meds.’
‘I do that.’
‘Okay. Great!’
‘I do everything. I get her up in the morning, I put her to bed at night, and everything in between. Not that she sleeps. Last night I was up at half past twelve, half past two, half past four, half past six…. I’ve not had a decent night’s sleep in years. She calls out in the night, you know. All the time. And I have to take her to the toilet. And then bring her back. And wash her down when she doesn’t make it. I don’t know how I’ve been getting through the day, I’m so tired…. I don’t know how I’m going to ….I don’t know…’
And suddenly he leans forward, puts his face in his hands, and cries.

Pat watches him from her wheelchair, then slowly picks up the beaker from the tray and takes a sip. A dribble of tea falls down the front of her dress.
‘Here, love. Sorry. Let me get that for you,’ he says, and wiping his nose on his sleeve, he hauls himself up, pulls a handful of tissues from the box, and starts dabbing her dry again.