tangled up in brown

I let myself in with the key from the keysafe.
‘Hello? Jack? It’s Jim, from the hospital…’
The bungalow is profoundly quiet, a heaviness to the air, cloying top notes of sweat and something else, the noxious atmosphere accentuated by the solitary drilling of a fly. Curtains drawn, a soupy brown half-light through drawn curtains. A door at the far end of the hallway standing open.
‘Hello…?’
Into the bedroom. The single bed on my immediate left rumpled up, nothing on it but a soiled bottom sheet, rucked up with a bias to the left; the contents of the side cupboard spilled or spilling; a chaotic pattern of smeared brown stains on the white wardrobe doors and across the floor – and then Jack, naked, lying on his back on the floor beside the bed, a lit desk lamp clutched to his chest, the cord tangled around his arms and legs. At first I think he’s dead, but then I notice a trembling in his abdomen, intermittent breaths, and when I touch him on the shoulder nearest to me, he shudders, opens his eyes and stares straight up at the ceiling, smiling in a beatific way, as if the touch was the answer to a long vigil of prayer.

I call for an ambulance once I know he’s breathing and stable. Even though they say they’ll do their best to get here quickly, and despite his poor condition and the likelihood of a long lie, he’s still only a medium priority and there’s a chance the ambulance may get diverted to something else. In the meantime I set about trying to assess Jack more thoroughly, and make him more comfortable. I put blue overshoes on, a plastic apron, gloves, and set to work. I turn off the lamp and gently disentangle him from the lead. After a quick top-to-toe that seems to exclude any obvious fractures, I use whatever pillows and bedding I can find to put under and around him to ease his position. I run a quick set of obs. I’m just about to go into the kitchen to find a beaker for water when Jack’s son Joe arrives. Joe is shocked by his father’s condition, but he manages to contain it for the future in the cause of setting things right in the present.
‘He was fine when I put him to bed at half seven last night,’ he says, putting on the overshoes and gloves that I give him, then helping me shift the furniture around to make room for the ambulance crew. ‘He’s had this UTI recently. The antibiotics haven’t been touching it. He was hallucinating about cats last night. He said the house was full of ‘em. I was going to talk to the doctor today to see what the plan was.’
He looks down at his father, and shakes his head.
‘Why didn’t you press your button, dad?’
Jack opens his eyes again and makes some incomprehensible sound.
‘He’s pretty dehydrated. I was going to give him some water,’ I say. ‘It’ll have to be in a beaker, though. His blood pressure’s quite low and I’m wary of sitting him up too much.’
‘I’ll see if he’s got one somewhere,’ says Joe, and pads off into the kitchen to find one.
Meanwhile I fill a basin with soapy water, get some dry wipes out of my bag and start cleaning Jack up. He’s in a terrible state. I’m guessing he must have had several episodes of diarrhoea through the night, the smear marks on the floor and wardrobe where he scrabbled around ineffectively. His hands are caked, his long nails thickly rimed, his body filthy – even the lamp is covered in smeary hand prints where he’s hugged it over night – for warmth, or light, it’s impossible to say.
I start work on his face and hands.
The ambulance arrives.
A paramedic walks into the room, clutching a clipboard.
‘Oh my good God!’ he says. And then, looking at my apron and overshoes, adds: ‘I don’t suppose you’ve got any more of those, have you…?’

please welcome on stage…

Buddy Holly is sprawled on the back of the sofa, Eddie Cochrane is staring down at me from the top of the wardrobe, and Elvis Presley is lying on the floor with his paws in the air, waiting to be tickled.
‘That’s so Elvis,’ I tell Pat, leaning in.
‘He’s still quite kittenish,’ she says. ‘You wouldn’t think he was twelve.’
Elvis grabs my hand with his front paws and rakes me with his back, but keeps his claws retracted. His mouth gapes, his eyes deepen to perfect circles of black, and his ears flatten.
‘He loves that,’ says Pat.
‘He totally looks like Elvis’ I tell her. ‘Maybe in his cape years.’
‘I thought about making him a cape once,’ she says. ‘But I didn’t want him swallowing the rhinestones. He eats most everything else.’
‘Okay. Enough now, Elvis. What about you, Pat? How are you feeling today?’
‘Oh I’m alright,’ says Pat. ‘I’m always alright. I don’t know what all the fuss is about.’
‘I think it was because you fainted and broke your hip.’
‘Yes but – these things happen.’
‘Do they know why you fainted?’
‘I got up too quickly. Eddie and Buddy were fighting and I had to sort them out. Next thing I knew I was staring up at them, and when I tried to get up my hip was agony.’
‘Did you have a carelink button then?’
‘No! It’s only since. No – I had to crawl to the phone. It was only on the hall table but it may as well have been the moon. Luckily Ian across the way has a key, so the ambulance didn’t have to break the door down.’
‘That’s something anyway.’
‘I was in hospital for ages. It was torture. My poor cats. I was worried sick.’
‘Did Ian look after them?’
‘No. He’s allergic. If he sees a cat on the telly he sneezes. No – they had to go to a cat hotel, out in the country.’
‘Sounds lovely.’
‘It wasn’t. It cost me an arm and a leg. And I don’t know what they spend the money on because it certainly isn’t food. They were half starved when I got them back.’

I can’t imagine any of these cats half-starved. I struggle to imagine how Eddie Cochrane makes it up to the top of the wardrobe without a hoist.

I run through the usual observations, blood pressure, temperature, SATS and the rest. Everything checks out. Pat’s blood pressure drops a little when she stands, but not precipitously, and ever since the accident she knows to do things slowly, in stages.

‘I’m guessing you like rock and roll then,’ I say, taking the pressure cuff off her arm and nodding in the direction of Buddy Holly, who’s sitting staring at me from the kitchen with such a fixed expression on his face I feel unaccountably possessed by the urge to walk over and open a tin.
‘Not particularly,’ says Pat. ‘I got them all as kittens, and they were so funny, I could just see them jumping around on stage, playing guitar.’

James the First

Rosie is more confused than usual, according to Rosie – the other Rosie, I mean, the one who lives at the end of the road and comes in most days to help. The fact that her husband Jim has the same name as me only adds to the confusion. He’s amiable enough, placid as an old turtle who swapped his shell for a corduroy jacket. If Rosie Two hadn’t introduced him as her husband, I’d think he’d tagged along by mistake. When she asks him to fetch in Rosie One’s address book from the kitchen, he wanders back in, flicking through a photo album.
‘Look at you in front of the Sphinx, Rosie!’ he says. ‘Well, well.’
‘Oh for heaven’s sake,’ says Rosie Two, and goes to get the address book herself.

Rosie One is sitting in her armchair, held in place by an enormous, ash-gray cat. The cat stares at me, its head bobbing up and down and its eyes pulled wide in time with the vigorous strokes. It extends its front paws onto her lap, presumably to spread the impact.
‘Poor Jonesie!’ says Rosie One. ‘I fell on him, you know. Squashed him flat! Broke my fall, though, didn’t you, Jonesie? Hey? You broke mummy’s fall, didn’t you? You clever thing!’
‘Tripped you up, more like,’ says Rosie Two, striding back in from the kitchen and handing me the address book. ‘That cat. It’s an absolute monster. Anyway. There! Karen’s number. The next of kin. Apparently.’
Jim Two has drifted over to the bookcase, tutting and exclaiming as he makes his way along the shelves with his head crooked so far to one side his ear is practically on his shoulder.
‘Well, well!’ he says, carefully sliding a book out. ‘Who’d have thought!’
‘Jim!’ says Rosie Two. ‘You’re supposed to be making breakfast!’
‘Am I? Oh, right,’ he says. ‘Absolutely. Of course. Breakfast. Yes.’
And he wanders away in the opposite direction to the kitchen with a book in his hand. Rosie Two goes after him.
‘Nothing’s the same since my darling husband died,’ says Rosie One.
She’s looking at a portrait on the sideboard, a broad-faced, smiling man in a white naval uniform.
‘I’m sorry,’ I say. ‘What was his name?’
‘Jim’
‘Jim? Not another one!’
‘Well,’ she says, turning back to me. ‘My Jim was the first.’

eek emoji

Mrs Geraldo is tidily stretched out on the bed, fully and immaculately dressed in a tartan bolero jacket, frilly white blouse with a rope of pearls around the ruff, corduroy skirt, thick black stockings and black court shoes, her hands neatly folded over her tummy, her legs crossed, her head supported by two crisply laundered pillows. It’s a double bed, the right side taken up with a collection of unusual cuddly toys – a horned goat, an octopus, a snail and so on. The room itself is as immaculate as Mrs Geraldo, bright paintings, silk drapes, silver framed photographs, richly coloured rugs on a polished wooden floor. It was one of these rugs that tripped her up a few days ago, which is why her hair is a little wild; the abrasion on the back of her head needs some undisturbed time to fully heal.
Standing at the foot of the bed is Gillian, her carer.
‘He wants to talk to you,’ she says, handing me the phone.
Mrs Geraldo’s son, Peter is calling from Darmstadt. I tell him how his mother is, what her observations are today, what the plan is. He takes all this on board then asks me how I got access.
‘Oh – erm – Gillian happened to be here. I phoned earlier to agree a time but no-one answered so I came round on spec. I’ve got a record of the keysafe but no-one seems to know the number.’
‘That’s right. You’re not supposed to know. That number is for the emergency services only.’
‘Okay.’
‘I don’t want any old person traipsing through the house stealing things.’
‘Right.’
‘If you need to visit my mother you make an appointment with Gillian. She must be there at all times.’
I glance at Gillian. She can’t hear the conversation, but from the face she pulls – essentially the eek emoji – I can see she understands.
‘That’s fine,’ I tell him. ‘Obviously it makes it more difficult for the nurses and therapists to come in and help your mother. Generally speaking we’d be using the keysafe in the same way as the emergency services – because that’s kind of what we are, too…’
‘Let me stop you there. If mother falls over and needs picking up – fine, the ambulance need to know the number. Everything else is to go through Gillian. Is that understood?’
‘Absolutely. Let me hand you back to her, Peter. Good to speak to you.’
Gillian takes it from me and talking very quickly and earnestly carries it off into the kitchen.
‘Was that Peter?’ says Mrs Geraldo.
‘Yes. All the way from Germany.’
‘He does worry.’
‘I can see that.’
‘Oh dear!’ she says, reaching up with her right hand to pat her hair. ‘You must forgive me. I look an absolute fright.’

one for the vault

It’d been a year since I last saw Vera. I remembered her clearly, though. A bracingly independent woman in her nineties, Vera had been non-compliant with everything – meds, treatments, appointments – and so utterly resistant to any offer of help she’d physically ripped up the paperwork in front of Marion, the physiotherapist, and handed back the empty folder. Reports were that Vera had declined a great deal since then, unfortunately. Several admissions to hospital with falls and so on. A recent stay for increased confusion, reduced mobility. Ill health had softened her up a little; she’d accepted a couple of care calls a day, and we were in the process of ordering a hospital bed, and doing whatever we could to set up a micro-environment so she could stay at home.
‘The doctors are saying palliative, not quite End of Life phase, but not far off,’ says Marlene, the lead nurse. ‘See what you can do.’

As soon as I let myself into the flat I know something’s wrong.
‘Vera? Hello? It’s Jim, from the hospital.’
A muffled voice from the bedroom.
I’m on the floor.

Vera’s lying so close to the door it’s tricky getting in. I have to take my jacket off, put my bag down, cheat a gap just wide enough to squeeze through sideways, and then reach back through for the bag.
‘Have you hurt yourself, Vera?’
‘No. But I can’t get up.’
‘Let’s just have a look at you.’
Vera has slipped off the bed, dragging the quilt down with her and landing semi-recumbent on the carpeted floor with the quilt rucked-up behind her back. As landings go, pretty neat. I check her over, just to be sure. She has no power in her legs, and she’s too big for me to help up on my own.
‘I’m going to have to call the ambulance, Vera.’
‘Look – never mind that. Just listen closely. There’s a leather suitcase over by the window. I want you to take it to the bank. To the manager. The manager will then lock it in the vault. D’you understand me? A leather suitcase! For the vault!’
‘Okay – but – first things first, Vera. I’m just going to call for an ambulance along to help with the lift, and when we’ve got you up and everything, we’ll think about the rest.’

The ambulance call taker goes through the usual triage algorithm, as tedious as ever, but I understand the reason behind it. Except – this particular call taker has an unfortunate tone, robotic and quite aggressive.
‘How long has the patient been on the floor?’ he says.
‘It’s hard to say. Vera’s not a particularly reliable witness, I’m afraid. But the flat’s nice and warm, she’s comfortable and not in any distress, so I don’t think any of that’s a problem.
‘Can you place your hand in the middle of the patient’s chest and tell me if they’re cold or not.’
‘I’ve got a thermometer in my bag. I could do a temperature if you like.’
He simply repeats the question, a little more slowly.
‘Look,’ I tell him, feeling riled, ‘I’m sorry but I’m not going to be placing my hand on her chest or anywhere else.’
‘Are you telling me that you’re refusing to carry out my instructions?’
‘I just don’t think it’s necessary.’
‘In that case I shall be making this case a higher priority.’
‘Great. Suits me. I don’t particularly want to be waiting here for hours.’
‘The patient has now been triaged as a Category Red 2 response: possible hypothermia.’
‘Fine. She’s not, but – whatever.’
I feel like telling him I used to be an EMT, but I don’t. It’ll probably make him worse.
He carries on with the algorithm, even though I offer to do a set of obs for him.
‘An ambulance will be with you shortly’ he says, giving me some worsening care advice and a reference number. ‘Thank you for your assistance,’ he says, coming to the end of the screen, and then adds, with a little shiver of personality: ‘Have a nice day,’ and rings off.

I’m halfway through my examination when the buzzer sounds. Five minutes later two paramedics come through the door – the lead one, Chloe, an old workmate of mine I haven’t seen since starting the new job. We kiss and hug and how are you and everything.
‘This is Prina’ says Chloe, introducing me to her colleague. We shake hands.
‘Me and Chloe go way back,’ I say to her, blushing slightly.
‘I didn’t think you were strangers’ says Prina.

I show them into Vera, who’s so comfortable on the floor she’s virtually asleep. I tell them the story of the fall and as much background information as I have. Between the three of us getting her up is easy. She has to go in to hospital, though. She’s not safe to be left at home – and really, shouldn’t have been discharged in these circumstances. Still, it’s always a difficult judgement call, complicated by issues of mental capacity and the incessant demand for beds.

Vera seems happy to go in – or if not happy so much as passively accepting. She’s cocooned in a couple of cell blankets on the paramedics’ carry chair, her frosty white hair spiking up out of the top, making her look like an enormous alien chrysalis retrieved from a glacier.
‘Don’t forget that suitcase!’ she says to me, suddenly perking up and wriggling dangerously from side to side on the chair like she’s about to break out and spread her wings. ‘It has to go to the vault!’
‘What suitcase?’ says Chloe, resting a hand on her shoulder. ‘What vault? Sounds intriguing.’
‘There’s nothing intriguing about it,’ says Vera, desperately chinning enough of a gap in the blankets so she can glare at Chloe. ‘It’s where I keep my manuscript!’
Chloe laughs.
‘I miss working with you,’ she says, smiling at me. ‘There’s always something – I don’t know…’ But then she straightens up and nods to Prina. ‘You’re great, too,’ she says.
‘Oh – get a room’ says Prina.