in plain sight

The operations centre – a thriller movie cliche. That tickety white writing at the bottom of the frame: Langley, Fairfax: 15:00. Or something. An office so ridiculously busy you can almost hear the echo of the clapper board and the director shouting ACTION!. Zoom in to a stressy operative hunched in front of a bank of computer screens, frowning, pressing the headset closer to their ear. ‘I’m sorry – can you repeat that?’ While a tense boss strides over and leans in. ‘Get me Moscow!’ or something. ‘I need eyes on the ground, the air. Goddamn it I want eyes on the eyes!’ And so on.

I’m talking it up. But the fact is, a large part of helping out on the clinical coordination desk is troubleshooting problems, however they present. A patient wanting to know what happened to a visit, a doctor with feedback on a treatment outcome, a clinician needing support, or numbers, or access codes, or availability for this, that and whatever else. A hundred requests, often at the same time, whilst a queue forms behind you of people wanting to discuss an earlier decision, or request clarification, or get the latest statistics, or hand you the latest flow diagram…

It’s a hectic environment – sometimes unbearably so – but once you’re set up at the desk, with everything open on the screen to give you what you need, your pad and pens and highlighters and snacks and three different mobile phones all laid out on charge, you start to feel like you can cope with anything, and find anything out, and coordinate the absolute shit out of the place. And now that I’ve found a headset to use with the phone, I feel even more prepared, because although the others laugh at me and think I’m overdoing it, still, I’m the one without the terrible crick in my neck from cradling the phone whilst I type, and I’m the one with my hands free to gesticulate if I think it’ll help. Plus I think it looks cool, so – whatever.

‘She’s gone, Jimmy.’
‘Gone? What d’ya mean, gone?’
‘She just disappeared. I rang the intercom. Jackie answered. She said come on up. She buzzed the buzzer. I went up the stairs. Five flights. No lift. Have you been there?’
‘No. But I’ve heard all about it.’
‘Five flights. Narrow – and so steep. It was like climbing a tree. So I got to the top, puffing and blowing. The door was open. I said Hello? Jackie? I went in. And she wasn’t there.’
‘Have you had a good look around?’
‘A good look around? Yes – of course I had a good look around. What do you think? Anyway – it is not a big flat, Jimmy. It is very small, like a bedsit really. Just one big room, a small bathroom, a tiny kitchen, and that is it. A little nest at the top of the tree. I even looked in the cupboards. Nothing. No sign. No Jackie.’
‘I don’t understand.’
‘So what should I do? I rang her next of kin and they could not say. She doesn’t really go out. And she doesn’t have a mobile phone, so it’s not like I can ring her.’
‘Let’s get this straight, Ada. You called Jackie on the intercom. She answered and let you in the main door. You walked up the stairs, five flights. Her flat door was open. She wasn’t in the room.’
‘Correct. And she’s very frail and elderly. It’s not like she could run down before me, or climb out a back window or anything like that.’
‘Maybe she went into another flat?’
‘She has the top flat. So she’d have to come down at least one flight to go to the next one. But why would she do that if she knew I was coming up? It is all very peculiar.’
‘The only other thing I can think of is that you didn’t actually ring Jackie’s flat number.’
‘Excuse me?’
‘Maybe you thought you rang her number but rang someone else’s by mistake. They answered – sounded a bit like her – they buzzed you in regardless. Maybe Jackie went out ages ago and left her door open.’
‘Hmm. Maybe. But I’ve been here before and it definitely sounded like her.’
‘Those intercoms can be deceptive.’
‘I’m not sure.’
‘Can you do me a favour, Ada?’
‘Of course. Anything. I’m here now.’
‘Can you have one last look around the flat. Even if it means looking under the bed.’
‘Under the bed? Why would she be under the bed, Jimmy? She is not a cat.’
‘No – but – stranger things have happened.’
‘If they have I’ve never heard of them. Under the bed?’
She says something I don’t catch, and makes a clucking noise.
‘Just have one last, really good look around the place, Ada. To reassure ourselves she’s absolutely and completely definitely not in the flat.’
‘Well… okay. But I tell you now for one thing – that woman is not here.’

Ada puts her phone down somewhere but leaves the line open. I listen to her as she harrumphs about the place, calling out Jackie’s name once or twice in a sing-song way, just exactly as if she’s trying to find a cat. After a minute or two I hear a startled ‘Oh!’ then a ‘Hello, Jackie! Just a minute, please…’ Then the sound of her approaching the phone, picking it up, and ‘I have found the patient, Jimmy.’
‘Where was she?’
‘Lying on the bed.’
‘Great!’ I say. ‘That’s a relief!’
‘Thank you for your help,’ says Ada. ‘Talk to you later!’ And she rings off.

I pull the headphones off my ears and stretch back in the chair.
Michaela sits down opposite me.
‘You’ve seen Jackie before, haven’t you?’ I ask her.
‘The old woman who lives in the attic? Yes, a couple of times. Why?’
‘Does she wear clothes that exactly match her bed linen?’
‘Does she… what?’
‘Nothing … it’s just …’
The phone rings again.
‘I’ll tell you in a minute,’ I say, and press pick-up.

of bugs and men

‘Just press the button at the top and let yourself in the main door,’ says Giles. ‘I’ll leave my flat door open.’
‘Great. See you in about ten minutes.’
‘Right you are. Goodbye.’

I’m not entirely convinced, though. Giles sounds drunk, speaking with that slow and over-elaborate articulation, tying each word off individually, like balloons.

I know Giles’ block very well. It’s a neat, self-contained complex, a sequence of four, ten storey buildings connected by a corridor and terminating in a bigger, more recent block for residents with higher dependency needs. It’s often the case that patients we see start in the flats at one end and finish in the flats at the other, like they’re being fed through some kind of slow-moving machine.

As I park up outside the entrance to Giles block, I see a gloomy, cadaverous man with long, frayed hair, wearing a string vest and yellow shorts, his left arm in a sling, like he put his shoulder out rolling the stone away from the tomb. He’s struggling to uncoil a garden hose from a drum, and even though it reminds me of a scene from Silence of the Lambs, I go over to help him.
‘Thank you,’ he says. ‘Could you unkink it for me, please?’
I put my book and bag down, and then carefully release the hose as the guy staggers backwards with the nozzle.
‘Are you alright there?’ I ask him.
‘Fine’ he says. ‘Now – could you turn it on when I shout?’
‘Okay. Just don’t be looking in the end when I do.’
‘I’m sorry?’
‘Don’t look in the end when I turn the water on.’
I jerk backwards in a comedy mime.
‘No,’ he says, then wobbles off round the corner of the block, the hose slithering behind him.
After a while it goes slack.

Time passes.

I start to wonder what’s happened, but just as I’ve decided to put my head round the corner and see what’s happened, he shouts: ‘Okay! Turn her on!’
The hose gives a shudder, and I hear a spraying noise.
I figure he’s watering the grass – which seems pretty futile. The scrubby little patch out front is so brown now it’ll take a monsoon and a bag of seeds to make it better.
I pick up my book and bag and then go round to talk to him. He’s standing there, spraying the grass with a tragic look, shifting his arm in the sling occasionally, staring through the water vapour and the little rainbow it makes.
‘I’m afraid I’ve got to go inside’ I tell him. ‘I’ve got an appointment with someone.’
‘Couldn’t you wait just a few more minutes?’
‘No. Sorry. He’ll be waiting.’
The man gives a desultory little sniff, and then turns his sad gaze back to the grass.
‘Bye then!’ I say, and turn back to the entrance.

Up on the fifth floor Giles’ flat door stands open, just as he said. I knock loudly, shout Hello Giles! It’s Jim, from the hospital!
No reply.
When he still doesn’t answer I go inside to check he isn’t on the floor. It’s quickly apparent the flat’s empty, though. I’m guessing he just stepped out for a moment, because there’s a cone of incense smouldering on a saucer in front of his chair, filling the room with so much smoke he may as well have set a bunch of tires alight.

I go back down to the car to make some calls.

The old guy watering the grass has gone, as has the hose. It’s so hot outside, what water there was on the drive has almost entirely evaporated.

I ring the office to check I’ve got the right address (I’m guessing I have, as Giles’ directions had been accurate). The only other explanation I can think of is that he popped round a friend’s flat and will be back shortly. I make a plan. If he still doesn’t answer the phone, I’ll go back up and knock on the flats either side to see if they know anything. Other than that, I can’t think what else to do. It’s frustrating, as I’ve got several more visits to make. I had thought this would be straightforward. But then again, it’s always the straightforward jobs that end up taking the longest.

I make one last call to his flat.
Giles answers.
‘Yes? Giles speaking.’
‘Oh! Hi Giles. It’s Jim again, from the hospital. I called up to see you but you weren’t in.’
‘I don’t understand. I’ve been here all along.’
‘Have you?’
‘Well – yes!’
‘Okay. I’ll be up in a second.’

Of course, Giles is the hose guy. He’s sitting in the chair wreathed in smoke from the incense cone, the same lugubrious expression, shifting the weight of his arm in the sling. He makes absolutely no sign that he recognises me from outside, or even that he’s moved from the chair at all. And for some reason, neither do I.

Just as I’m getting ready to do the examination, there’s a vigorous knock on the door and two huge guys in tight blue t-shirts and white powder gloves thump into the sitting room.
‘Bed bugs!’ the older of the two says. ‘We’ve come to check your mattress, mate!’
‘Be my guest!’ says Giles, waggling the yellowing fingers of his right hand.

The bug guys go into the bedroom.

Giles tells me about his poor health lately. He drinks a lot of whisky, he says. He was assaulted by a blind man at a bus stop. He’s in dispute with the police, the hospital – really, it’s such a long and complicated list, I lose track.

The bug guys come back in.

‘All done!’ they say, and turn to go.


Later on, when I’ve finished the examination and left Giles to kipper quietly in front of his cone, I see the bug guys again, stomping down the stairs in front of me. And maybe it’s an effect of the incense, or the sudden blast of fresh air, or both, it’s hard to say, but suddenly I feel quite exhilarated.
‘Beeeeed Buuuuuuug Maaaaaan!’ I sing.
The older of the two looks round at me and frowns.
‘Don’t,’ he says.

not exactly Lear

Zikri and I have been asked to do an environmental assessment on a patient.

‘What is this environmental assessment? What do they mean environmental assessment?’ says Zikri, saying it so emphatically again and again it sounds like a sneezing fit. He rapidly flips the page backwards and forwards like he’s trying to shake the sense out of it by main force. ‘They’ve already said it’s unhygienic and dreadful. Faeces on the floor etcetera, a terrible mess. What more do they think I can add to that? Hmm? A colour chart?’
I love working with Zikri. He’s a zesty combination of warmly humane and emphatically pragmatic. With his slightly greying goatee and his steel framed glasses, and his habit of staring at you with his mouth slightly open, like he’s savouring everything you have to say, and preparing himself to jump in with warm words of praise or a stinging rebuke. He’s the best teacher you never had. He’d have made a great theatre director, or maybe an oncologist. You could take any amount of criticism from Zikri and still think he’d given you a compliment.
‘He asked Anna to leave. So she did. She wasn’t able to complete the assessment, but she was there long enough to get this much done. Nowhere does it say she thinks he lacks capacity. And now we’ve been asked to go in and do an environmental assessment. I think all we’ll be doing is making him angrier and less inclined to co-operate than he already is.’
Zikri takes his glasses off and pinches the top of his nose.
‘Well, okay, alright,’ he says at last. ‘What time do you want to meet there…?’


I’ve been to a great many scenes of self-neglect, both in the ambulance and latterly as a community health worker. But I have to say Mr Frederickson’s basement flat is by far and away not anything like any of those places. In fact, I’d go as far as saying it’s actually very nice. It has a warm, stripped pine floor; walls populated with framed playbills, woodcuts of seabirds, watercolour landscapes, family photographs; quirky, vintage furniture; palms in jardinieres, and a view through a bright sash window of a rich and well-tended courtyard garden. I can’t help thinking we’ve come to the wrong house. In fact I’m so certain that must be the case, I quickly check the paperwork as Zikri makes the introductions.

‘It’s lovely to see you both,’ says Mr Frederickson, shaking our hands and then tying his dressing gown more tightly around his waist. ‘You catch me rather déshabillé, but then I suppose it is the weekend, so perhaps you’ll let me off.’

He’s utterly charming.

Zikri looks at me.

I know exactly what he’s thinking.

Environmental assessment.

‘If you’d be so kind to pass my apologies to your colleague,’ says Mr Frederickson, ‘… the girl who came here the other day. I’m afraid she caught me at rather a bad time. I stood there with my hair all over the place. I must have looked like Lear on the heath. I think I scared the poor girl out of her wits.’
‘No worries,’ says Zikri. ‘We will be sure to convey your apologies’
‘That’s kind of you,’ says Mr Frederickson. ‘Now – how can I help you this morning?’
‘Well…’ says Zikri.