The District Medusa’s / confused / but used to it / curses as she struggles to tie on a mask / past the rattlers, vipers and asps / ignoring the patient’s frantic objections / that he really doesn’t want an injection / flailing and wailing with his eyes squeezed shut / but / when the DM cracks her dusty knuckles / he opens his eyes so she smiles and chuckles / advances the needle but the needle buckles / okay stony / you great big phony / she roars / tossing the broken needle on the floor / grabbing her bags and kicking through the door / I’ve got a busy day and I just can’t plan it / when every patient turns to granite
I’ve come to do Elaine’s assessment with Lisa, one of the physio assistants. Elaine is eighty, her cancer advancing rapidly towards end of life, to the point where she needs a great deal more equipment and care. The District Nurses want her to go into a hospice, because she has no family or friends to help out, she’s isolated and vulnerable where she is, and there’s a limit to what the various community health teams can do. Elaine doesn’t want to go, though, despite numerous falls and incidents. The DNs have referred her to us to see what else we can provide, including night sitters.
We’re told that Elaine is able to buzz us into the building with a remote device, but when we ring her number there’s no reply and nothing happens. The building manager isn’t in his office, so we push the emergency buzzer on the console. Because we don’t know the password, and the door’s not camera monitored, they won’t let us in. We ask if they’ll phone the hospital and check that way. It’s not part of their protocol, they say. They can’t do it.
‘She might be on the floor,’ says Lisa.
They ring off.
Lisa curses, buzzes random flats. Eventually someone takes pity on us and lets us in.
Luckily, Elaine’s door is unlocked. She’s sitting on the floor leaning back against the bed. The only injury she has is a skin flap on her arm, so together we gently help her up again and settle her back in bed. I check her over and dress her wound.
The phone rings. Lisa answers on Elaine’s behalf.
‘It’s Dwayne,’ she says. ‘From the Salvation Army. He says he’ll call back later.’
Elaine nods, gently raising and then lowering her uninjured arm like a marionette sadly acknowledging some change in her surroundings, then she gently closes her eyes and rests her head back. She’s so frail and emaciated she hardly makes any impression on the pillow.
‘Dwayne is so sweet,’ she says. ‘There are two of them, you know.’
‘Buy one get one free,’ says Lisa.
Gently holding the primary dressings in place, I wrap Elaine’s arm in a bandage.
‘I used to play tennis with this guy,’ I tell her. ‘It was only a year later I found out he had an identical twin. For some reason it just never came up. I went round to pick him up one day and when he came to the door I thought Whoa! What’s different? He just stood there looking at me whilst I tried to figure it out. Was he wearing new glasses? Has he cut his hair? What was it? After a while he said So I’m guessing Simon never told you he had an identical twin? It was so weird! They were the same but different. Very unsettling.’
‘I’ve not met Dwayne’s brother,’ says Elaine. ‘I’ve only ever seen pictures.’
‘What’s his name?’
‘What – they’re both called Dwayne?’
‘No. Dwayne’s called Dwayne. I don’t know what the other one’s called. Something or other, I expect.’
‘I was gonna say. If you had identical twins you wouldn’t call them both Dwayne. It’s confusing enough.’
‘I dunno,’ says Lisa. ‘Might make it easier.’
I tape the bandage.
‘There! Good as new!’
I gather all the rubbish together.
‘You know – it’s only recently I found out you can’t have identical twins of different genders,’ I say, peeling off my gloves, adding it to the waste bag, then putting it in the kitchen bin.
‘You can, actually,’ says Lisa. ‘It’s pretty rare, but it can happen. It’s all about the fertilisation. If you get two eggs developing in the uterus you get fraternal twins; if you get one egg that splits in two you get identical twins, boy boy or girl girl. But then sometimes one of the halves drops the Y chromosome and you get boy girl identical twins. Very rarely though. See what I mean?’
‘‘How do you know all this stuff?’
She winks and points.
‘Stick to the bandaging, Florence. Leave the science to me.’
Elaine tentatively flexes her bandaged arm.
‘Oh dear,’ she says. ‘I look like Boris Karloff.’
She sighs and closes her eyes again.
‘Maybe I had better think about that hospice,’ she says.
Her name is June Bergh so of course I write Bug.
She drifts around the house like a June Bug, too – a hapless bumping into things that’s as much to do with cataracts as anything else. She’s perfectly happy in spite of her ailments, though.
I wish I could say the same for her husband, Derek.
‘Now what?’ he barks as the phone rings, glaring at me from the thickets of his eyebrows as if he’s wondering whether to answer it or strangle me with the cord. I offer to help him out of the chair, but he bats me away. ‘I’m not senile yet!’ he says – then spends the next couple of minutes waggling himself forwards in the chair, paddling his great slippered feet, rocking backwards and forwards with his arms on the armrests to get some momentum going, then pitches forwards so alarmingly I can’t help reaching out to stop him plunging head first into the fireplace. ‘I’m perfectly alright!’ he snaps again, finding his balance, then trudges away to answer the phone, which I can’t believe is still ringing (although I’m guessing they’ve rung before and know to wait).
June and Derek are both in their nineties, married for seventy, as moulded together in their ways as two ancient EPNS tablespoons back of the cutlery drawer. I’ve come to dress the wounds on June’s legs and see how she is generally, which I have to say is pretty good.
‘Oh no,’ she says. ‘I never go to the doctor’s and he doesn’t come here. I couldn’t tell you the last time I saw him. I don’t even know if it’s a him.’
The long-term care of June’s legs should really fall to the District Nurses, but they’re the most stretched of any of us and have to triage their workload ruthlessly. Anyone remotely capable of leaving the house will simply be referred to their local surgery and the practice nurse. June has already told me she goes out from time to time – for hair appointments, to see a friend a few miles down the coast, occasional shopping trips and so on – all by taxi, or one of a circulating cloud of nieces and great-great whatevers. When I suggest she sees the practice nurse once a week, she pulls a face.
‘I’m ninety-four!’ she says. ‘I don’t go to the doctor’s! Besides, you can’t get an appointment.’
Derek is shouting into the phone by this point. It’s obviously about something clinical, and I’m tempted to intervene to clarify, but he turns his back for privacy, so I take that as a no.
‘You try ringing them!’ says June, warming to her theme. ‘You can be sitting there with the phone in your hand dead-on half past eight and it’ll still be engaged. And when you finally get through there’s nothing left. No! I’m sorry! If they want me, they know where to find me.’
Just as I’m wondering how to change my line of approach, Derek hangs up and lumbers back to his chair.
‘Who was that, dear?’ says June.
‘Well what on earth does HE want?’
‘He wants to come and take your blood. So I told him. Good luck with that.’