losing centre

There’s something so vague about Mrs Graham, something so detached, the view out of her living room window, across all the trees and rooftops of town, feels strangely appropriate, like she’s a balloon and someone let go of her string.
‘Wow!’ I say, putting my bags down. ‘That’s quite a view!’
‘Is it?’ she says. ‘I suppose you’re right.’
She sits neatly in her armchair and waits for me to begin.
She’s watching gymnastics on the television with the sound on mute. A female gymnast flic flacs across the mat in the floor exercise, lands, arches her spine, throws her arms high and wide in showy gestures, then takes a couple of sprung skips and hurls herself back in the other direction.
I explain to Mrs Graham who I am and what the visit is for. She listens to me carefully, but she obviously has no idea, no recollection of having been in the hospital, let alone being brought home by the Red Cross just about an hour ago.
Quite how she’s able to live alone like this I’m not sure. She has carers four times a day, and her daughters live at various points around the city, but hour to hour? It’s a mystery. Environmentally the flat is as safe and hazard free as it’s possible to be. There are no immediate trip hazards, things are neatly squared away, the medication in a locked box. My notes say that the cooker is disconnected, there’s a stairgate to discourage her from going downstairs, there are notes taped to various doors with simple instructions – but with such a poor level of recall or understanding, I can’t imagine how she gets by. She was admitted to hospital with a chest infection and not a fall, though, so that’s some reassurance I suppose.
The gymnasts have moved on to the asymmetric bars. A different competitor has just smacked chalk on her hands, acknowledged the start with a hyperflexed gesture, then thrown herself with a half twist through the air to skip across the bars and begin spinning and curling and doubling back.
I ask Mrs Graham what she used to do before she retired.
‘A biochemist. I’m Dutch, originally. I met my husband just after the war and came to England to work. It was a long time ago,’ she says, staring back at the TV. ‘I was a dancer, too,’ she says, without breaking her gaze. ‘There’s a picture of me over there…’
She gestures behind her without looking. I go over to see – and there she is, a young woman en pointe, arms arched delicately above her head, a headdress of white flowers, a tutu. She’s looking wistfully off into the distance stage left, which – given where the picture is hanging – is pretty much directly at where she’s sitting now.
‘Lovely’ I say.
‘Thank you,’ she says, then gives a little flinch as the gymnast tumbles through the air at the end of her routine, lands a little off-balance, puts a foot out to recover, draws it back when she’s found centre again, straightens, acknowledges the crowd, then strides off.

stand by me

It’s Fifties karaoke at the Eventide Residential Care Home – so loud the care assistant who answers the door has to lean in to hear who it is I’ve come to see.
‘In the conservatory!’ she shouts, laying a hand on my shoulder. ‘Are you alright to give the injection there? I’ll put a screen round.’
‘Fine!’
She hurries off to fetch it, and I wait with my bags in the hallway. I don’t want to add to the chaos in the lounge. They’ve set the chairs back around the edge of the room to make space, but even so it’s looking pretty busy. There are residents dancing with the staff, relatives slumped on chairs next to sleeping residents, a handyman struggling through with a box of tools (who decides that doing a restrained kind of jive is the easiest way to make any progress); a kitchen assistant keeping everyone topped up with tea and biscuits, the whole scene dominated by a gigantic, floor-to-ceiling plastic christmas tree flashing its lights in and out of time to the music, and a giant plasma TV screen on the wall, scrolling through the lyrics of the current song.

It strikes me you could take any Fifties hit and find a poignant match with the scene in a home for people suffering from advanced dementia.

Now playing?
There Goes My Baby – The Drifters.

I decide to sit down on a padded bench to keep out of the way until the assistant returns.
An elderly woman in an electric blue dress and pure white hair swept up in a bun comes and sits next to me.
‘How are you today?’ I ask her.
She smiles in a non-committal away and shakes her head from side to side.
‘Love the decorations!’ I say, glancing around. The truth is – they make me feel a little scratchy. We’re not even done with November, and here we are in a thorough-going grotto, surrounded by strobing lights, silver lanterns, baubles, tinsel – as thickly applied as if someone had been given a box of tack and told to empty it in five minutes or else. What makes the effect even more dizzying is the number of mirrors around the place, one behind the bench, and one behind the reception counter opposite, so that whichever way I look, the decorations, my reflection and the reflection of the woman sitting next to me are replicated over and over and over, smaller and smaller, all the way to infinity.
‘Lovely to have the music!’ I say to the woman.
She shakes her head, smiling coyly. And then – just as I think she’s happy not to speak but just to sit there, she suddenly leans in and starts an intense monologue, so random I struggle to follow the logic of it.
‘Oh!’ I say – and then, tapping my ear – ‘Sorry! It’s really hard to hear with everything going on!’
The woman laughs and slaps my knee, as if I’d said something shocking, just as the assistant comes back, pushing the kind of hospital screen you might see in a Carry On film.
‘Alright?’ she says. ‘Put him down, Samantha! This way!’

The assistant uses the screen ruthlessly, like a kind of snow plough, but even so, getting through is a tricky business. I end up jigging about in her wake with a couple of residents. One of the relatives slumped in the chairs gives me a sad kind of smile.

Now playing?
Ain’t That A Shame – Fats Domino.

The conservatory is obviously being used as a refuge for any resident who doesn’t care for rock n’roll. Margaret, the patient I’ve come to see, has a blanket over her head. Her daughter Leonie is sitting next to her, looking as washed-out as the mug of tea she cradles.
‘Margaret?’ says the assistant, gently stroking her hand and then slowly pulling the blanket clear. ‘The nurse is here to give you an injection.’
‘Lucky you!’ says Leonie, looking at me with a smile that segues into a grimace.
Margaret looks outraged.
I kneel down in front of her.
‘I’m so sorry to disturb you, Margaret! It’s a real nuisance, I know – but I’ve been asked to give you another one of those injections? Is that alright?’
‘It goes in your tummy,’ says Leonie. ‘It’s not so bad, mum. D’you remember? From yesterday?’
If Margaret does remember she makes no sign, looking down at me in horror.

Another assistant comes through with Margaret’s yellow nursing folder and a box of Enoxaparin. There’s nowhere to set the folder down and fill out the scrip, so I do my best to do it all in mid-air whilst the assistants negotiate enough space to put the screen around Margaret’s chair. I’m on the outside of it for the moment, which is fine – except I’m immediately accosted by a tiny woman as fierce and pointy as a vole in a twinset. She stands by the screen and starts picking ineffectually at the fabric whilst muttering bitterly about something.
‘Are you okay?’ I say to her. ‘We won’t be long.’
She comes right up to me and starts talking quickly and severely – about what it’s impossible to know.
‘I love this music!’ I say at an opportune moment. ‘What d’you think? Do you like rock n’roll?’
She starts back, frowning in such an angry way I think I might have touched on exactly the wrong thing.
‘Classical? Maybe they’ll have a classical session next week…?’
Luckily the assistants have finished setting up the screen. The second assistant leads the angry woman away whilst I duck behind the screen and prepare to give the injection. It all goes smoothly, thank goodness. Leonie kisses her mum and puts the blanket back over her head whilst I clear up and the assistant folds the screen away.
‘I’ll just take this back then I’ll let you out,’ she says, pushing it through the lounge.
‘Okay. Won’t be a second.’
As I’m writing a brief note in the yellow folder, the resident in the chair next to Margaret, a large, slack-faced man in a business suit two sizes too big, holds out a Ribena carton to me.
‘No thanks!’ I say. ‘I’m fine!’
But then he shakes it, I realise it’s empty and he wants me to take it away.
‘Yep! Okay!’ I say, balancing it on the folder with the rest of my rubbish.
It’s easier getting through the lounge, thank goodness. The music is slower and the floor has cleared, apart from the angry woman doing a slow foxtrot with the second assistant.

Now playing?
Stand by Me – Ben E. King

poirot wraps it up

Every now and again Geoff screws up his mouth at the side and ticks air through his teeth. It’s the kind of thing a builder or a mechanic might do before they quote for a difficult job.
Funnily enough, Geoff used to be a builder. He was active into his seventies, but then suffered a series of health problems, including a stroke that affected his right side, recurrent chest infections, and now his latest and most challenging problem, dementia. His wife Lena is normally home to look after him, but Lena’s been admitted to hospital with an MI – which is why Geoff’s GP has referred him to Rapid Response. Geoff’s dementia is low key at the moment, but he does get confused in the early hours, and has a tendency to wander and do dangerous things. We’ve been tasked to provide bridging care and night sitters to keep him safe until a regular agency can pick-up. I’ve come by to take some obs, see how he is.
‘I’m fine’, says Geoff. ‘I’m okay. C’mon! Feel that grip. No, no, not the right hand. The right hand’s the shite hand…’
His right is hooked over in a kind of claw, but his left is certainly strong.
‘Wow!’ I say. ‘That’s impressive!’
‘I was known for it,’ he says. ‘Now…’ He shrugs, makes the ticking noise again, then turns his attention back to the TV.
Poirot is wrapping things up, surveying a room of characters, building up to the big reveal. I don’t know who looks more bored – Poirot, or Geoff.
Behind the wide-screen TV is a wider-screen window, looking without interruption over the sea. It’s calm today, a clean, silvery slice of light. Dotting the horizon are several dark vertical lines – an offshore wind farm. I read somewhere they’ll provide the power for half the houses in the county. That’s a lot of houses. A lot of Poirot.
‘My son’ll be here later to take me to the hospital, says Geoff, cradling his bad hand. ‘I try to get over to see Lena most days. I know she worries about me.’
‘Have they said when she might be coming home?’
‘Nah! They keep changing their minds!’ he says. ‘Nobody knows anything!’ He turns his attention back to Poirot, so I do, too. The camera’s right on the detective, so tightly that his lugubrious face fills the entire screen. I half-expect him to look straight at us and say Ah! Monsieurs! But it is perfectly plain to me when Mrs Lena is to be discharged from the hospital. It will be next Monday. At approximately half-past eight. And YOU will be there to greet her!
Then wink, and curl his moustache.

Geoff screws up his mouth.
Tick.

a tumbleweed of barbed wire

If I was a comic I’d be dying on my arse. In a tiny, Thirties-themed, immaculately hoovered comedy club. Three people in the audience, two of them arms folded, stony faced, one of them smiling (the one with dementia).
It’s bracing, to say the least.

‘I’m not wearing a bra’ says the elderly woman.
‘That’s alright. Neither am I’
Tumbleweed.
‘Who are you again?’ says the son.

I’d been expecting an easier gig. I’d rung the first listed next of kin, a daughter called Louise. She’d been so chatty and friendly on the phone – sorry she wouldn’t be able to make it down today, she was caught up at the stables… not in a bad way… horses? who’d have them…. that kind of thing… but it was okay… her brother and sister in law would be over to meet me… thanks for ringing… thanks for everything, and so on.

Walking into the house was like walking into a wall. Made of ice.
‘So – what are you?’ says the son.
‘A nursing assistant.’
Assistant?’
‘Yes. Well – my official title is Assistant Practitioner. But everyone just thinks that means I’m a doctor. So I never call myself that – unless I’m ringing a surgery, in which case it helps get past the receptionist.’
Another tumbleweed. Probably the same one.
I can feel myself starting to sweat, even though the room is actually pretty cold.
‘Are you registered?’ he says.
‘No. But I’ve got a lot of experience, and the rest of the team are just a phone call away.’
‘I see.’
(I wish I was a phone call away. At the very least.)
‘What team?’ he says.
I describe the make-up of the response team. It sounds inauthentic, like I’m reading off an autocue.

I’m not sure which of them is tougher, the son or the daughter-in-law. It’s not good cop / bad cop. It’s bad cop / awful cop. I have a giddy, out of body experience, where my temporal body carries on talking, but my ghost unplugs, drifts over, raps on their foreheads, and finds – to no great surprise – they’re actually made of tin.

‘…so, we get referrals from the GP, the hospital or the ambulance, and we go in and annoy the hell out of people in the cause of making sure the patient is safe to be left at home.’
A tumbleweed the size of a small planet. I wish I could jump inside and roll away, like one of those big, plastic balls. Zorbing, is it? Geo Balls?

They’re staring at me.

I try to shake myself out of my funk and focus on the patient instead. That’s who I’m here for, after all. I have no idea why they’re being so hostile. It could be any number of reasons – they’re stressed to the gunnels about something, they’re annoyed they had to come out here instead of Louise, they’re angry with each other and taking it out on me, they’re terribly shy and it just reads as defensive – but frankly, I’m here for the patient, and anyway, she’s much warmer and more fun than they are.
I go through the usual routine of taking blood pressure and so on. I use all my best lines. The patient likes it, but Mr and Mrs Medusa just glare at me from the sofa.
‘I just need to take your hearing aid out so I can do your temperature,’ I tell the patient.
The son stands up.
‘Let me do it,’ he says. ‘They cost two thousand pounds.’
‘Thanks,’ I say. ‘I’m scared of those things.’
His wife snorts.
‘Don’t let him any where near them,’ she says, meaning her husband, thank god. ‘He left his in when he went for a swim in the sea.’
‘Oof!’ I say. ‘Apart from that – how was the holiday?’

A tumbleweed of barbed wire.

get it right

Mrs Heywood is ninety-seven but looks older. She’s lying in bed tucked up to her chin, hands gripping the quilt either side of her face, blinking anxiously and rapidly, like an ancient dormouse in a converted matchbox in an illustration by Beatrix Potter.
‘Please help me,’ she squeaks. ‘Phillip hasn’t been in. I can’t remember the last time Phillip was in. Not the carers, not anyone. Please help me.’

I might be worried – if I hadn’t passed the carers on the front door, just leaving, and if the carers hadn’t told me that Phillip had been in that morning and was due back at lunchtime. And even without those things, I would still have guessed Mrs Heywood was mistaken about things, by the warm mug of tea, cup of fresh water and plate of bourbon biscuits on the trolley by the bed, the newly-ordered and spotless shine of the commode, the neatly folded clothes on the armchair, the general air of everything having been done.
‘Don’t worry, Mrs Heywood. I’ll do your blood pressure and what have you, make sure you’re alright, then I’ll call Phillip and we can have a chat about things. How does that sound?’
‘I’m terribly ill,’ she says. ‘No-one’s been in.’
She’s so thin, I have to change the cuff for an infant size. Despite her frailty, though, all her observations are good.
‘Let me write it down before I forget,’ I say.
Mrs Heywood pulls the quilt more tightly about her, frowning and pouting, like a child who’d been put to bed for no reason, and I was writing a letter to the teacher or something.

Flipping through the folder I notice that her surname has been spelled in two ways – Heywood and Hayward. I ask her which is right. She levers herself up on both elbows, lowers her chin and fixes me with a severe expression: ‘It’s Heywood!’ she says. ‘H-E-Y-W-double O-D!’ Then, after a pause to satisfy herself I’ve received the information, she carefully lowers herself flat again, and draws the quilt back up to her chin.

Just then the front door opens and a man’s voice says: ‘Hello? Mum?’
‘Phillip!’ says Mrs Heywood, sitting up again.

A second later and Phillip clumps into the room. He’s a heavy, hearty-looking man in his mid-sixties, with a chin so square and scrubby he could kneel down and sand the floor with it. As he stands there looming over us in his vast fluorescent yellow tabard, dusty combat trousers and beaten Caterpillar boots – it’s impossible to think of Mrs Heywood ever giving birth to such a figure. We shake hands, mine getting lost in his hefty builder’s paws, calloused and capable, a grip that could dent a pipe.
‘I tried ringing you before I came but it just went to voicemail,’ I tell him, in case he’s cross I’m here without him.
‘Yeah – sorry about that,’ he says, swiping off his beanie and scratching his head. ‘I got the message, but reception’s terrible. Anyway – I was only working round the corner so I thought I’d pop in and catch you.’

After we’ve settled his mum we go into the kitchen to chat. His demeanour rumples a little when he talks about their situation. His dad died a couple of years ago, it hit his mum hard, her dementia’s getting worse. She’s got carers four times a day and Phillip comes in as often as he can, but he doesn’t think it’s enough. She’s up and down, often unhappy, doesn’t remember things. It’s becoming dangerous.
‘She’s had a few falls,’ he says. ‘The only reason she hasn’t hurt herself is ‘cos she’s so light it’s like dropping a feather. Thing is, all this time she’s always been dead against going in a home. Don’t you go putting me into one of them places she says. I’m not going into no old people’s home. But I can’t think what else to do. I know you can get live-in carers, but she wouldn’t want someone strange in the house. It was hard enough getting her used to the carers. It’s a worry, that’s for sure.’
‘Maybe you could try getting her in for a spot of respite. Just for a couple of weeks. See how she goes. My bet is she’ll settle right in. There are people there all the time, keeping her company and making sure she’s safe. There’s a lot of resistance to the idea of residential care, but it’s not what they think. She’d have her own room, nice n’ cosy, familiar things around her. I think she might like it.’
‘How do we go about doing that, then?’
‘There’s nothing to stop you looking around for yourself. Asking people for recommendations. But if you’re worried about the financial side of things I could always get a social worker to talk to you. This is more their domain.’
‘Could you? That’d be great. I just need to get a clear idea of where we are and what’s to be done.’
‘I’ll do it today.’
I start coughing. Phillip pulls out a packet of Fisherman’s Friends cough lozenges.
‘Try one of these!’ he says. ‘I swear by ‘em. When you’re outside all the time you need something with a bit of a kick.’
It certainly has that – and it stops me coughing.
‘I’ll tell you the best cold remedy,’ says Phillip, putting the packet back in his pocket. ‘Drop one in a glass of vodka. Sloosh it round. Down in one.’
‘A bit like sloe gin for builders.’
‘Something like that,’ he says.

After I’ve said goodbye and let myself out, I notice a huge lorry parked outside the house. On the side of it, in great, big, block white capitals: HEYWOOD & sons.
H-E-Y-W-double O-D

peas in a pod

The moment I press the front bell a furious howling and barking starts up deep within the house; a half second later, a malevolently dark shape starts leaping up and down the other side of the door, battering itself against the frosted butterfly glass, crazy as a baby wolf on a trampoline, doing everything it can to get to me bar setting up an oxy acetylene cylinder and cutting a hole through the panel. A minute or so passes but the dog doesn’t tire. It even seems to be trying out some fancy moves – a half-tuck, a forward roll. Eventually, a light goes on. A shadow coalesces through the butterflies, three pane zones into one.
‘Shashi! Shashi! For goodness sake – shush now!’ A chain rattles back, a lock turns, the door opens. Despite myself, I can’t help drawing back, expecting the dog to launch itself at my throat; instead, it trots out quite happily to sniff my shoes, as if it was only contracted to bark so long as the door stayed shut.
‘Lovely to see you!’ says June. ‘Sorry about Shashi. She sounds terrible but she’s perfectly harmless.’
‘Her bark’s worse than her bite.’
‘Well her bite’s pretty bad, to be honest, but since she had her teeth out she’s calmed down in that respect.’
I’m relieved.’
June leads me through to her living room. It’s a tidy space, dominated right and left by two enormous Georgian-style doll’s houses. Each house has a little patch of garden in front, surrounded by a white picket fence. In the garden of one, two elderly dolls lounge in deck chairs, reading the paper; in the other, a doll mows the lawn with a dog exactly like Sashi following behind.
‘Have a seat,’ says June. She gets into position to sit down herself, unaware that Shashi has already jumped up onto the armchair and – apparently – fallen asleep.
‘Watch out!’ I say.
‘What? Oh – d’you mean the dog? She’ll move.’
I can hardly watch. June drops down into the chair immediately above the dog, which only moves at the very last second, reaching out with a paw to whip its tail out of the way as June lands with a weighty sigh.
‘There!’ she says. Then looks around.
‘I don’t know where the other is. They’re thick as thieves, normally. Brother and sister. Peas in a pod.’
I’d spoken to June’s son before coming here today. He’d talked to me about June’s increasing problems with dementia, her loss of short term memory, her habit of leaving the cooker on, door open, bath running. The whole thing is moving towards residential care, but for now the family were looking at increasing the number of carers during the day.
‘It’s been a difficult few days,’ he says. ‘Yesterday we had to have one of the dogs put down. The vet came out and it was pretty awful, but I’m not sure Mum remembers too much about it.’
I look over at Shashi. She’s left June’s armchair to curl up on one of two plush, tasselled red cushions on the opposite sofa. As if she can read my mind, she raises her head and stares at me.
‘Don’t!’ she seems to say.

what more can I say

I’m sitting with my daughter in a large and crowded waiting room at the health centre. No-one’s talking much, just the occasional appointment confirmation and instruction at the reception desk, the rustle of magazine pages, some self-conscious throat clearing, whispered conversations. What dominates the room is an elderly woman in a wheelchair. I’m guessing she has some form of dementia, because she keeps saying the same two sentences, over and over again.
There’s a carer with her, one hand on hers. She’s doing her best, but the elderly woman is relentless.
‘I’m not well’ she says. ‘I’m not well. What more can I say?’
Now and again she clears her throat with a vigorous, dredging cough, making as much of it as she can, like a cartoon voice-over artist vocalising the scene where a rabbit vomits up a grizzly bear, gives itself a shake, then blithely hops off as the bear stares after them.
‘I’m not well. I’m not well. What more can I say?’
In the context of the waiting room it’s strangely hypnotic, especially with the carer making periodic shushing and soothing noises, the whole thing coming together like the libretto of a spare modern piece: The Waiting Room, maybe. The Poor Patient.
‘I’m not well. I’m not well. What more can I say?’
Actually, I like the way she says what more can I say. She falls into it, high to low, in a helpless, rush, landing flat on the say.
‘It’s okay, Fenella’ says the carer. ‘Don’t worry. Everything’s fine. We’ll see the doctor soon.’
‘I’m not well. I’m not well. What more can I say?’
When I chat to my daughter, Fenella takes it as a cue to speak more loudly. The receptionist peers round the stack of folders on her counter, and frowns.
The carer is doing her best, but it’s difficult for her and I wonder about their situation. I’m guessing Fenella is an inpatient in a nursing home. Normally they have a GP who visits regularly through the week, to spare the patients – and the staff – the stress and risk of an outpatient appointment. I can only think that they’ve come to see a specialist holding a clinic, someone who won’t make individual trips. I’d like to ask the carer about it, but I’m not at work, it’s nothing to do with me, and anyway, she’s got her hands full.
‘I’m not well. I’m not well. What more can I say?’
I look over my shoulder and smile at the carer, who gives me a polite but slightly wary acknowledgement. I can see she’s stressed.
‘Don’t worry, Fenella,’ she says. ‘Here – let me rub your shoulders.’
She turns in the chair, reaches round and starts gently massaging the back of Fenella’s neck.
‘Oh – that’s lovely!’ says Fenella.
The whole waiting room relaxes.