clive’s familiar

Clive lives in a grotto
(portmanteau word: rotten, grot and odour)
there’s a foetid curtain hanging across the bottom of the stairs
that reminds me of those doors
you used to bang through on the ghost train
Beware! Horrors ahead!

Clive is not sitting in his armchair
so much as being slowly consumed by it
he’s smoking a fag, artfully balancing
a long and crooked stack of ash
with the wizened fingers of a mummified count
‘hello’ he says. ‘And who might you be?’

Clive doesn’t want any help, thank you
he’s quite happy as he is
he already has a heap of equipment
(toilet aid, perching stool, zimmer frame)
tossed in a bath that last saw water
when Nasser blockaded the canal

Clive has a cat on his lap, a placid brindle coloured animal
(though it’s perfectly possible that, along with everything else,
the walls, the furniture and me, probably,
it’s actually a snow white cat kippered by all the smoke)
‘He’s lovely,’ I say. ‘What’s his name?’
‘She!’ says Clive, losing his ash. ‘It’s a girl. And I call her Thingummy’.

a head for depths

Craig has the key so we agree to meet outside Sally’s flat at midday, when he’s due to make her lunch.
‘Have you been here before?’ he says, bending down to stretch some blue plastic covers over his trainers.
‘I hear it’s bad,’ I say, taking some out of my bag.
‘It’s not the worst, but you’ll definitely need these.’
Craig seems tired, a reflection of my own state of mind. It’s not so much the number of patients on the list and the number of miles we cover, hurrying from place to place. It’s more the endless parachuting in to situations that are failing in one way or another, trying to set them straight – or, at least, straight enough so you can feel some kind of progress is being made, and that things might change for the better.
An adult safeguarding report has already been put in on Sally, but it’s complicated. In the meantime, we’re going in to do what we can to ameliorate the situation.
‘Okay then.’
He knocks on the door and then opens it with the key.
‘Sallly? It’s Craig – and Jim. From the hospital. How are you doing?’

He’s right. Whilst it’s not as bad as many places I’ve been in, it’s definitely the kind of place you have to start with shallow mouth-breathing for a minute or two, till you’ve adjusted sufficiently to breathe normally through your nose. Walking down the hallway, our covered shoes make the ticky-tacky noise so characteristic of encrusted and unsanitary surfaces, and the air has a familiar and gloomy sag to it.

Sally’s waiting for us in the lounge, in an armchair so low and squashy and discoloured it looks less like a piece of furniture than some giant, malignant bloom. She’s wearing an electric blue silk nightie with a green cardigan over the top. Her bare legs are mottled, swollen, pressed together at the knee. She smiles easily, reaches up to shake our hands, but her conversation is muddled and difficult to follow. One of my tasks is to take some blood, to determine whether infection is making her more confused, but I can see I’m going to have to sidle up to it.

Whilst Craig busies himself preparing a microwave meal in the kitchen, I chat to Sally about this and that, and take her observations as carelessly as I can, almost as if I’m as surprised as her to be doing it.

When Sally talks it’s the equivalent of pretend writing. The patterns of her words, the fact that they follow a line, and start and stop in the usual way, with the usual loops and flourishes, everything looks superficially like conversation. But the truth is, I have to make assumptions about what she might mean, and reflect it back to her, and she’ll either laugh or frown, or wave her hand in the air, and we’ll move on, as if something’s been said, though neither of us really knows. But there’s the reassurance of the tone of what we’re saying, if nothing else, and it does seem to be working. She’s distracted sufficiently to let me take some blood, and whilst she obviously doesn’t have mental capacity to refuse, I take the fact that she doesn’t pull her arm away as consent.
Just before I actually puncture the vein, I ask her some more about her family, particularly her father, who (I think) she said was a miner.
‘Have you ever been down a mine?’ I say, preparing the needle.
She answers with a laugh and a string of garbled words that, if they were in a foreign language and I was forced to guess the meaning, I would say: That was a long time ago now / He was a lovely man / He worked so hard.
‘He sounds great!’ I tell her. ‘You know – I’ve always quite fancied the idea of going down a mine.’
She laughs again.
The blood flows into the tube.
‘God knows, it must be a difficult job.  But I quite fancy seeing what it’s like. I mean, when you think where it all came from, what it was, all that coal. Millions of years ago, all these giant trees and plants in some wacking great swamp somewhere, and then it all gets buried and changed into black rocks you can burn. I know I probably wouldn’t pay much attention to any of that if I had to go down in a cage every morning and swing away with a pick. If that’s what they do. I’ve really no idea.’
She listens to me with a tolerant smile on her face, tutting at some things, frowning at others, but keeping her arm still so I can get what I need.
‘There! All done!’ I say, taping a piece of gauze to the crook of her arm. ‘You’re a model patient!’
Meanwhile, Craig has come through with lunch. He’s standing just behind me with a tray of Lancashire hotpot.
‘You thinking of a career change, Jim?’ he says, helping Sally get set up in the chair, ready.
‘Me? Maybe,’ I say, stashing the phials of blood and peeling off the gloves. ‘I don’t know though. I’m not sure I’ve got a head for depths.’

mr stabby

The worst blocks have the loveliest names.

Carnelion House. By rights it should be bold, angular, cut from a solid block of plastic. Not a few, desultory storeys thrown like a bad cap over a huddle of failing shops.

You’d never know it was there. Even the SatNav’s embarrassed, blindly and hurriedly planting its red-button flag somewhere in the general area. The name of the block had fallen away years ago, so even if you parked exactly at that spot, and looked around, you’d never see it. And if you asked someone walking by in the street, no doubt they’d say: ‘Nah mate. Never heard of it. Unless they lived there. In which case they’d say: ‘Who wants to know?’

I only know Carnelion House because I went there once on an ambulance call. It was one of those addresses we tended to know, an ambulance lore of warning, passed from person to person in the way that a knowledge of obscure and dangerous reefs are communicated naturally between sailors. We used to have a lot of calls to Carnelion House, domestic abuse, assaults, overdoses and so on. The last time I was there the patient who’d taken too much heroin threatened us with his needle. I can picture him now, slumped on the edge of the bed, a line of drool shining from his bottom lip as he gripped the needle in his fist, point-down, like a dagger.
‘You come near me an’ I’ll stab yer in the fuckin’ EYE’ he said.
He obviously wasn’t quite as unconscious as reported, so we let the police go ahead of us with their vests and gloves and no-nonsense demeanour.

‘Wow! I’m impressed you knew where to go!’ says Connie, as I park up and lead us both to the discrete front door.
‘I’ve been here before.’
‘In the ambulance?’
‘In my dreams.’
I buzz the buzzer.

It turns out to be the same flat as Mr Stabby. I recognise his flat mate, Paco, an extraordinary guy holding himself painfully, in a semi-crouch. With his haunted eyes and his long greasy hair partially obscuring his face, he reminds me of that drawing of Nebuchadnezzar by Blake.
‘Hello,’ he says, gruffly, then letting go of the door, lurches precariously back towards the bedroom.

It may only have been two or three years, but things have headed south at a pace. These days Paco barely makes it out of bed. He has a bucket by his side for toileting. Someone on the same landing brings him food now and again. Maybe pays his TV licence, rates and so on, I don’t know. He’s been deemed to have capacity to make decisions for himself, so any attempt to engage by various services have met with little or no success. It’s only a recent ambulance call that’s brought him back into focus. And it feels as if maybe things have changed enough to convince him to accept help.

‘I’m sorry it’s such a mess,’ he says, collapsing back on the bed, the same bed Mr Stabby was sitting on when he made his vow to me. ‘But you see, my carer died.’

happy days

Ralph reminds me of that woman in Happy Days – not the Fonzie sitcom, the Beckett two-hander. She’s buried up to her waist in a mound of crap, but seems oblivious, wittering on to a taciturn husband who sits at the bottom of the heap passing her stuff every now and again. Ralph isn’t quite buried, but it wouldn’t take much. A sneeze would do it. He’s lying precariously on his side on the very edge of a large double bed that’s piled high with rubbish. And it’s not just the bed. The whole flat is submerged, with only a trackway through the rubbish to get you from the front door to the bedroom and – at a push – to the bathroom. At least the budgie in the front room has a cage to protect its space from the rising tide of crap, although quite how Ralph ever manages to make it over there to feed and clean it is a mystery. The bird sits on its perch flicking its head in spasms of attention as I pick my way through to Ralph, who calls to me from the bedroom.
‘The bag needs changing,’ he says.
He’s right. His catheter bag is as tight as an overfilled water bottle, straining at the seams, filled with a sloughy, orange-tinged mess.
It’s hard to know where to begin. There’s nothing in the flat to clean him up, scarcely room to put my bag down let alone install equipment. We often talk about setting up a micro-environment for anyone with significantly reduced mobility. That means having all the essentials to hand – a commode, urinal, frame to help with transfers, maybe an over-bed table for food and water, a phone nearby and so on. I can’t help noticing that Ralph has already set up his own version of the micro-environment: a pile of porno mags, a remote control and a combat knife.
I’m half-way through sorting out his catheter when I hear a knock on the front door.
‘Who’s that?’ I say. He shrugs.
When no-one comes through, I go to check.
The front door is slightly ajar. Just in front of it on the floor, about an arm’s length from the threshold, a big bag of bird seed.