portrait

Ella’s flat faces the sea – so close you could run out of the front door, across the road and dive straight in. When I step out of the car I can’t help but stand for a moment and take it all in. There’s a break in the morning rain, the sun is shining powerfully, and suddenly the sea is a phosphorescent slice of pure light. The wind turbines on the horizon are as clear as I’ve ever seen them, delicate cuts of white, their rotors imperceptibly turning against the inky clouds of the next weather front.

When I’d rung ahead to make the appointment, Ella had said to use the keysafe to let myself in. It’s a complicated arrangement, though. Ella’s flat is on the ground floor, but because the building is in a conservation area the keysafe has to be hidden away in the basement. ‘It’s in the second cupboard on the right,’ she’d said. But the front door is in the centre of the building with two windows either side, so in fact there are two basement flats, right and left of the main steps. It feels intuitive to take the steps down the right hand side basement, but when I get there I find only one cupboard, fixed with a rusting padlock. So I go back up, down the other steps, find the keysafe, retrieve the keys, come back up. There are three keys on the keyring; none of them fits the front door. I stand there stupidly for a minute, jangling the keys, trying to figure out how this could possibly make sense – until I look up, and realise I’ve actually gone one door along.

As it turns out, I didn’t need the keys. Ella’s son Peter and his wife Becky are with her. Ella stands in the middle of the living room, still in her hospital gown, tags on her wrists, holding on to her zimmer frame, whilst they put her shopping away.
‘I bought you plenty of pineapple,’ says Becky, holding up a plastic carton as big as the fruit itself. ‘I know you like it.’
‘Where does this go?’ says Peter, waving a pack of panty liners in the air.
‘Bedroom cabinet, second drawer down,’ says Ella. And so on.

The room is like a domestic version of a royal court, the walls dressed in rich tapestries and huge, abstract paintings, the furniture a mixture of ethnic and modern, the rug on the floor intricately patterned. With the sunshine streaming in through the windows, the whole thing has a rich, painterly feel, like Caravaggio decided to branch out from biblical scenes, this one called: ‘The Hospital Discharge’.

‘Let’s get you sat down,’ I say to her. ‘Then we’ll talk.’
She shuffles over to a chair set in the middle of the room, very much like a throne, with claw feet, woven back, and – incongruously – a pressure cushion.
‘I feel absolutely dreadful,’ she says when she’s settled.
‘In what way, dreadful?’
‘Just that. Dreadful. What more do you need?’
‘Are you in pain?’
‘Pain? Everywhere, darling.’
‘Where do you feel it most?’
She waves a hand in mid air.
‘Agony,’ she says.
‘Do you feel sick?’
‘Sick? No.’
‘Short of breath?’
‘I’m always short of breath. Haven’t you read the notes?’
‘Yes, but I just want to see how you are right now – if anything’s worse, or about the same…’
She closes her eyes and gently shakes her head.
‘If by the same you mean dreadful, then yes, I’m the same.’
‘I’m sorry to hear that.’
‘And I’m sorry to feel it.’
‘I got you some of those yogurts you like,’ says Becky, from the kitchen.
‘I couldn’t possibly,’ says Ella. ‘Not in a million years.’
‘Well – I’ll put them in the fridge for later.’
‘If you must.’
‘Right. I’ll just do some obs and then we’ll take it from there,’ I say, unpacking my bag and then kneeling in front of her chair.
‘Obs?’ says Ella, suddenly glaring down at me. ‘What d’you mean, obs?’
‘Observations. Your blood pressure, temperature, that kind of thing.’
She sighs, then closing her eyes and resting her head back, holds out her hand – whether it’s for me to kiss or put the SATS probe on, it’s hard to say.
‘If you think it will help,’ she says.

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.

the waiting room

It’s one of those houses that opens out in a surprising way, like ducking through the tiny arched doorway of a church and finding yourself in a great vaulted space. The sitting room is positively sepulchral, filled with a honeyed and dusty light from the casement windows at the far end. In the corner of the room there’s a hospital bed, a zimmer frame and commode, and then spreading out from there, a selection of easy chairs set along the walls, giving the place a sombre, waiting room feel. Around the walls there’s a patchwork of family portraits, all of them with such eager and fixed expressions, it wouldn’t surprise me if their eyes lit up when the actual person approached to take up their spot in the chair immediately beneath.
‘In some ways we were fortunate,’ whispers Raymond. ‘in that we had a lot of this equipment for grandma’s last months.’
‘That was lucky,’ I say, feeling uncomfortable about using the word luck in this context, the mother’s decline segueing neatly into the son’s.
‘By the way,’ says Raymond, leaning towards me. ‘Please don’t mention the C word.’
He taps the discharge summary on my lap, and the phrase Bladder TCC / declining further investigation, and then raises his eyebrows, to emphasise the point.
His father, Geoffrey, is surprisingly chipper, given the circumstances. He’s lying in the hospital bed, propped up with pillows, reading the paper. He’s so blasted by illness his flesh has fallen away – so much so that his glasses have slid to the end of his nose, because there’s only the vomer to keep them in place. It feels like I’ve been invited into a mausoleum and found a man prematurely set to rest there, filling the time as best he can, current affairs, quick crosswords, sudoku and so on.
‘Don’t mind me,’ he says, raising his chin to keep the glasses in place as he flips the page.
The family are doing a fine job looking after him, though. Raymond is the focal point of the whole operation, living in the house, putting in most of the work and efficiently co-ordinating the rest. In fact, Raymond is such a palpable force, it’s hard to resist the idea that he’s keeping his father alive by a conservative power of will.
‘We definitely do not want daddy going back to hospickle’ he whispers.
‘‘What are you saying now?’ says Geoffrey, laying the paper and his glasses aside.
‘Nothing, daddy. Nothing,’ says Raymond, standing up. ‘Would you like some more tea?’