jarring

Muriel had a fall recently. She hurt her neck, so they put her in a support, a fat, white fabric affair that pushes her chin up and makes a presentation of her face, a modern riff on the Elizabethan ruff. Muriel doesn’t look too happy about it. In fact, her expression is intensely mournful. You could draw her face pretty quickly as a series of downward curves: two for the eyes, two smaller ones for the nostrils, one big one for the mouth.

‘I’ve popped in to see how you are, Muriel. And the physio asked me to give you this zimmer frame.’
‘Oh yes?’ she says, leaning forwards but not actually opening her eyes. ‘Why would I want that, then? I’ve got my stick.’
‘Your stick’s great, but this is safer,’ I say, slapping it twice, like some kind of dodgy market trader. ‘They say you’ve had a few falls lately, Muriel, so hopefully this’ll help.’
‘Everyone’s been so kind,’ she says, turning away and heading back to the sofa. ‘I don’t know. I just don’t know.’

The referral had come from the ambulance, but we’ve had plenty of follow-up calls, especially from the neighbours. They’ve seen her wandering outside the house at all hours, distressed, confused. At least now there are several people on the case – the GP, social services, mental health and other nurses. A night sitter has been booked to keep an eye on things tonight, but a decision will have to be made soon as Muriel isn’t safe to be home alone.

I help her settle back on the sofa. I offer to make her a cup of coffee and find some biscuits.
‘You don’t mind if I watch my quiz?’ she says.
‘Of course not.’
‘I like my quizzes.’
‘I bet.’

The TV is playing one of those afternoon shows where the set is so emphatically neon it makes you feel hysterical. I wouldn’t be able to answer with my own name, let alone who played James Bond in Dr No. The quizzes always have to have a gimmick. This one seems to be about lists. The contestants answer questions on a subject, and either go through and win some money, or not. Warwick Davis presides over the whole thing with a smile as bright as his shirt.
‘Let’s play Lists!’ says Warwick.
I escape into the kitchen.

It’s so orderly in there I wonder whether this confusion is more an acute thing, or whether Muriel already has help of some kind. Everything’s exactly where you’d expect it to be. Utensils hanging in height order from a rack. Chopping boards neatly aligned. There’s even coffee in a jar marked ‘Coffee’. When I fetch the milk out of the fridge, the souvenir magnets are all lined up in alphabetical order. There’s a big ceramic bear on the counter. When I twist its head off I find it’s filled with mini cookies. I grab out a handful, arrange them in a circle on a saucer, and take it all through on a tray decorated with kittens.

On the telly lights are flashing and klaxons sounding, so I’m guessing someone is going home empty-handed.
‘There you go, Muriel!’ I say, putting the coffee and biscuits on the table beside her. ‘I’ll just write up my notes in the folder then I’ll leave you in peace.’
‘Righto,’ she says, tossing down the cookies one after the other, crumbs already sticking to the powdered hairs on her chin.

The yellow nursing folder is in the middle of a circular dining table on the far side of the room. There are no chairs round the table, except for a green plastic garden chair with a wooden box on it. The box has a brass plate – commemorating the ashes of her husband Frank who died just a couple of years ago. It’s strange to see the box there. It’s such a formal, substantial thing, like a miniature coffin. I wonder whether Muriel’s taken it down from somewhere to clean it, or whether she moves it about and talks to it. I try to imagine how I’d feel, having it around the place, like I’d been interrupted on the way to the cemetery. Something like the cookie jar would be friendlier and less – well – jarring.

‘Let’s play Lists!’ says Warwick.

Frank’s nest

Sixty years ago, when Frank was a young man, he worked in the shipyards, on the cranes. At least, I think he did. He’s got such a strong Geordie accent, and speaks in such a slurred and rumbling kind of way, it’s impossible to be sure. There’s a half empty bottle of whiskey tucked discreetly on the floor behind his legs, too, and I’m sure that’s not helping things.
The kitchen is oppressively hot. I’m wearing full PPE. My apron feels so tight I feel like a big, blue sausage beginning to squeal under the grill.
‘Ah’ was fitter in them days,’ he sighs, staring out of the kitchen window. His little flat is on the uppermost floor of a converted house, with plane trees so close to the front it’s as if we’re sitting in the cab of a crane high over the street. ‘I didn’t gi’a shit about nuttin’!’ he says, swatting the air with his good hand. ‘Ah was scamperin’ about like one of them squirrels there. Ah used ta stand wi’ ma legs on the girders, swingin’ ma’ hammer, snakin’ out the wire…it was like ah’ was buildin’ a big nest for meseln’ in the sky.’
‘Wow,’ I say, wiping the sweat from my forehead with my arm. ‘That sounds amazing!’
He stares at me for a second, like he’s trying to get me in focus.
‘D’you mind if ah’ smoke a tab?’ he says, reaching for his tin.
‘Could you wait a bit, Frank? I’m almost done.’
‘Oh. Okay.’
He pushes the tin back, and sighs again.
‘I can open the window if you want?’
‘If yer don’ mind.’
It feels good to let the air in. Frank closes his swollen eyes and turns his face in the direction of the breeze. He had a fall in the kitchen a couple of days ago. Got taken to hospital and kept in for observation. To look at him you’d think he’d pitched head first out of the window. Livid purple bruises distort his eyes and face, there’s a steri-stripped laceration to his forehead, a bandage on his hand.
‘Ah’m sick of it,’ he says, opening his eyes and turning to look at me again. ‘Sick of it! Ah jes’ don’t want to go on, to tell ya the truth.’
‘I’m sorry to hear that, Frank. It’s understandable, though. You’ve got a lot on your plate. Do you want to speak to one of our mental health nurses about how you feel?’
‘Nah – what’s the point?’ he says. ‘Ah’ll jes’ carry on as I am, thanks very much. Tess’ll be in later wi’ ma things.’
I imagine her labouring and cursing up the six steep flights to Frank’s flat, shopping bags filled with microwave meals, fags and whiskey.
On the wall behind him is a calendar with a picture of a Matchless motorbike, one of the small, single cylinder machines, drop handlebars, bucket seat, cafe racer style.
‘Nice bike’ I say, nodding at the calendar, then wiping my forehead on my arm.
‘Ay’ he says, turning stiffly in the chair.
‘Did you ride?’
‘Whey aye! Ah tell ya, man – I was that fast – I’d be there a’fore I left.’

how to make an impression

‘To begin with, I’m not Cedric. I know it says Cedric on my birth certificate and all those official places, but it’s really a terrible mistake. I wouldn’t have the faintest idea how to be a Cedric. I think my parents must have lost at cards or had some kind of fit or something. So although it says Cedric, please feel free to ignore it and call me Bill. Everyone else does.’
He settles back in his armchair.
‘The bathroom’s through there if you’d like to wash your hands,’ he says.
‘It’s okay. I’ve got a bottle of hand cleanser here.’
‘As you wish.’
I take a small bottle out of my bag and pull the cap off. I’m a little heavy-handed, though. When I squirt some foam onto my left palm, a gob flies over and lands on the leather pad of an antique writing desk.
‘Oops,’ I say. ‘Sorry.’
‘Will it stain?’
‘I shouldn’t think so.’
‘Here. Give it a dab, would you?’
He passes me a pressed cotton handkerchief and I gently pat the area. It doesn’t look great, but I’m hoping the difference in colour is due to the wetness rather than any damage caused by the antiseptic soap.
‘Oh,’ I say. ‘Have you got any polish? I’m sure that’ll sort it out.’
‘Hm’ he says. He takes the handkerchief back from me, folds it up and puts it on the little table next to him.
Bill is so immaculately dressed – hair oiled and combed to one side, silver moustache trimmed to an even millimetre around his mouth, a precisely knotted tie just visible at the V-neck of a treacle-coloured jumper, an ironed crease running mid-leg down to a pair of monogrammed slippers – he hardly looks real. In fact, he’s so perfect I wouldn’t be surprised if, when he stood up and turned sideways, he revealed that he was in fact a tall, beautifully illustrated, two-dimensional bookmark.
Funnily enough, Bill used to be an antiquarian bookseller, a job he strode into when his frigate docked for the last time after the war. It’s easy to imagine him, sitting at the back of the shop, reverentially turning the pages of a rare book, then swiping off his glasses and getting down to business.
‘One thing I do want you to do is look at my back,’ he says.
‘Because of the fall?’
‘Yes.’
‘So what happened, Bill? I read the ambulance report but I wouldn’t mind hearing it from you.’
‘Would you? Very well. It happened about a week ago now. I was getting out of bed to visit the bathroom in the early hours, as one does. Especially at this age. Several times. So anyway, I sat there a moment on the edge of the bed, collecting my thoughts, berating my fate and so on, and I thought – I wonder what the time actually is? So I reached forward to look at the watch I keep on the dressing table. Well – for some reason that I cannot account for, that simple gesture extended, and extended, and the critical point came and I just couldn’t help myself. I think as I rolled forwards I must have turned and caught my back on the dressing table, because apparently I have a mark there that rather supports the supposition.’
‘Okay. Let’s have a look, then.’
He stands up, and then holds on to his zimmer frame whilst I untuck him and expose his back. As well as a livid, generalised bruise across the upper left side, there’s the impression of one half of a dressing table drawer – the corner of it, mostly, with some of the ornamental handle – everything picked out in a livid red line.
‘Ouch!’ I say. ‘That’s pretty harsh! It’s so clear I could almost read you the name of the cabinet maker.’
‘Yes. Well – it is a fine piece. I bought it at auction fifty years ago. Probably paid a little over the odds but what can I say? It rather made an impression on me.’
And he gives me a perfect, stage wink as he begins the painstakingly slow process of gathering together his many layers and tucking himself back in.

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.