a bottle of banana-flavoured drink

No-one knew why Alf was dying, but anyone could see that he was.

And as far as I could tell (it was difficult to ask), nobody knew why he’d refused any of the tests that might reveal the cause, chance of recovery, or time left. He’d been clear about that – certainly clear enough to reassure the medical team that he understood the consequences of his actions, and that his refusal wasn’t simply another manifestation of his illness. He may have explained his decision to them in detail. I expect he did. For us, the community health team, we simply had to accept that Alf had declined any further intervention, and wanted to be cared for at home. I can only guess why that was. Maybe he knew that anything they tried would be hopeless, and he’d lose his last weeks in a fog of operations, pain, nausea, medication. Maybe he was resolved simply to wade out with his eyes closed, and let the dark waters close over him. When I met him he was as passive as an anatomical doll, frail and uncommunicative, submitting to being rolled and cleaned from time to time, and not much else.

Alf’s deterioration had been so precipitous the family had started to gather in earnest, flying in from the extreme ends of the country, and abroad. The home they came back to was as unrecognisable as their father. Everything was in turmoil. There was a hospital bed in the front room, looking like it had been beamed up from a ward somewhere and crash-landed amongst all the fishing trophies and wedding portraits and domestic ephemera of a life. And it wasn’t just the bed. There was an abundance of medical supplies and pieces of equipment, the kinds of thing you need to treat an end of life patient at home, and beyond that, every available space was now given over to the cause, to temporary put-you-ups, and suitcases, and clothes hanging over balustrades, and then extemporary family huddles in the kitchen, or the garage, wherever they could gather together, and drink tea, and whisper severely, and let the old family rivalries play themselves out, as they ever will when families get back together for any reason, but most especially now, when one of their number is dying. They’d hurried across hundreds – even thousands of miles – and now they were here they found there was little they could do. Along with their horror of the situation they had to cope with boredom, and frustration, and being separated even temporarily from their own lives and problems, for an indefinite time. They relieved each other from their vigils at the bed. They did what they could to stay afloat. But the house was an anteroom of death, and the fact that no-one explicitly knew why made it worse for them.

Leah had been the first to come down. Leah had problems of her own. She was almost as skeletal as Alf, except in her case it was an eating disorder she’d struggled with for years. She tried to encourage her father to drink some of her own supply of fortifying milkshake, holding the straw to his lips and making softly encouraging noises.
‘He doesn’t want it,’ said her sister, Mae, her arms folded.
‘It’ll do him good. It’s designed to.’
‘Yes, but he doesn’t want it.’
Leah was wearing a strappy summer top that hung down from her, revealing the cruel extent of her illness. In fact, you’d have to say that there was only a degree or two of difference between Leah’s physique and her father’s, except – Leah was clearly on this side of the line, and he was on the other, and she was reaching over with her little bottle of banana-flavoured, fortifying drink, trying to do for him what she’d been trying to do for herself all this time.
‘He doesn’t want it’ said Mae.
‘But he might,’ said Leah. ‘Give him a chance.’
Mae was right, though. Alf’s eyes were already preternaturally large, made of some dull, inferior kind of glass, whilst Leah’s were still bright, and vital, and full of tears.

when the time comes

Margaret’s daughter-in-law Sandy is standing over by one of the bookcases, casting her eye over the spines, taking the odd book out and idly flipping through.
‘Quite what we’ll do with all these when the time comes I don’t know,’ she says. ‘I mean – it’s a shame. These Dickens might’ve fetched something, but the sun’s got to them and they’ve gone a bit foxy.’

It makes me feel uncomfortable, but it’s my own fault, of course.

I’d started setting up to take blood from Margaret, and Sandy and the two carers had been standing round the bed, saying nothing, just watching.
‘I’ve never had such an audience,’ I said, just to break the tension, because it didn’t really bother me whether I was observed or not. ‘Talk amongst yourselves.’
‘Sorry!’ Sandy said, and that’s when she started to walk round the room, pricing things up.

As it turns out, though, I’m glad the attention has switched to Little Dorrit. Margaret is quite poorly, and getting anything remotely viable is like trying to tap-up a strand of hair. I’m not even sure why I’ve been asked to try. Margaret has steadfastly refused hospital – and I’m completely with her on that. She’s in her nineties, for goodness sake. If I was her I’d be refusing hospital, too. The only thing I might do differently is ask them turn my bed around so I could face out into the courtyard garden and that flowering cherry, so vibrantly and abundantly pink it would gladden even a dying heart.

‘Alright?’ says Sandy, coming back over. ‘Getting any?’

the very model of gentleness

Midday, and the sun is the blinding centre of everything, scorching every surface, every car bonnet, brick wall, bare arm; blazing over the city; bubbling in the gooey tack of the road; dry-frying the leaves on the trees; flaming across the intersection of every street, irradiating everything with its vast and pitiless eye. It feels as if the sun has moved in close, into some newer, more punishing orbit – on a grudge, on a whim – and it absolutely will not quit until the last squeak of moisture has been drawn from the cell of every living thing.

Which is to say, I’m hot and thirsty.
Even winding up the car windows when I park feels like an act of madness.
In the seconds it takes to step out, I’m sweating.

Agnes’ daughter Janice meets me at the door.
‘Gosh, it’s hot, isn’t it?’ she says.
Inside the house is dark and cool.
‘The doctor’s still here,’ she says.
‘Great!’
I follow her upstairs.

Doctor Middleton is sitting on a blanket chest quietly fanning himself with a magazine supplement.
‘Hello Doctor,’ I say, putting my bag down and reaching out to shake his hand. ‘I’ve been sent to take some blood.’
‘Excellent!’ he says. ‘I suppose you know the circumstances?’
‘Just the basics.’
‘Well let me fill you in. Agnes has taken to her bed the last couple of weeks. Nothing specific. A little abdo pain perhaps but you could probably ascribe that to diverticula disease. No diarrhoea, no nausea or vomiting. No distressing symptoms particularly, other than this loss of energy and appetite and general decline. The weather’s not helping, of course – it certainly is warm – but let’s just say it’ll be interesting to see what the bloods show. If you’d be so kind as to throw the net wide – kidney, liver function, infection, anemia, that sort of thing. And put it in as urgent, if you wouldn’t mind. And we’ll take it from there. Okay? Great.’
He looks from me to Janice then back again, smiling broadly, shining in the close heat of the bedroom. Then he puts the magazine down, picks up his things, and with a large, friendly wave, heads for the stairs.

I turn my attention to Agnes. She’s lying on her side on furthest edge of the large bed, her left hand crooked under her head, her right hand resting on the point of her elbow. She’s staring at a small, white fan that’s been set on the floor, angled up so that a current of air plays gently across her face.
Janice sits down on a wicker chair just opposite – a position I’m guessing she’s held these past few days – as I kneel at the side of the bed and gently stroke the back of Agnes’ hand. When she opens her eyes and looks at me I explain who I am and what I’ve come to do. She listens passively, allowing me to straighten her right arm, put on the tourniquet, and tap up a vein. She barely reacts as the needle goes in and I draw off two phials of blood.
‘There! All done!’ I say, taping a little wad of gauze over the wound.
‘What do you think’s wrong?’ says Janice.
‘I don’t really know,’ I tell her. ‘The observations the doctor took don’t seem to point to anything. Has it been a marked decline, would you say? Or was it more gradual?’
‘A bit of both,’ she says, and by way of illustration raises her hand in the air and swoops it back down again, like she’s describing a rather lacklustre ride she took at the fair.
‘I wish I knew what was wrong.’
‘Well the bloods will certainly give a good indication. You’re doing the right things. though. Keep Agnes cool, give lots of fluids – doesn’t matter so much about food at this point. And we’ll take it from there.’
The phone rings, so I mime a Goodbye. She waves and smiles, and I see myelf out.

The first thing I do when I get back to the car is open all the windows. The seat is uncomfortably hot when I sit down, but at least there’s a scrap of breeze now, so I don’t need to drive off immediately and find somewhere shadier.

My habit is to make sure I have all the details I need for these phlebotomy jobs, take the sample and then fill in the form and the labels on the phials when I’m back in the car. It’s a long and fiddly bit of admin, and I don’t want to bother the patient any more than I have to. So it’s only when I settle in to do the paperwork that I notice Agnes’ date of birth.

She’s well over a hundred years old.

It makes me think of my friend Jo and his old sheepdog, Lewis. When Lewis reached the very end of his life, he took to lying by their garden pond. The last time I saw him, in fact, the day before he died, he was in his usual spot, his head between his paws, staring with his eyes half closed at the ripples in the water his fading breath made. And I think of Agnes, upstairs on the bed, quietly staring at the little white fan spinning round and round.

I drop the bloods off at the hospital.

It’s only at the very end of my shift, when I’ve arrived back at base to handover my caseload, that I hear Agnes died – an hour or two after I left. Apparently an ambulance was called, and because there was no DNACPR, the crew had to go through the resus protocol.
‘Unsuccessfully, surprise, surprise,’ says the co-ordinator, clicking her pen and pulling a fresh report sheet towards her. ‘I’m amazed there wasn’t one in place, but who knows? Maybe the family refused. You never know with these things. Shame though.’
‘I certainly wouldn’t want anyone jumping up and down on my chest when I was in my hundreds,’ I say, taking a seat next to her. ‘Or sticking me with needles, come to that.’
‘No. Me neither,’ she says. ‘Maybe it was you taking blood that pushed her over the edge.’
But she immediately smiles, and pats me on the arm.
‘Only kidding,’ she says. ‘I’m sure you were the very model of gentleness.’