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.’

to rinse or not to rinse

Ken is sitting in his pants, sprawling out of the armchair, his long arms and legs pointing east, west, south east, south west, as startling to look at as a giant species of starfish unexpectedly brought up in the nets.
‘Hot, in’t it?’ he says, just managing to lift a hand to acknowledge me as I come in. ‘I think I might actually be melting…’
At least he has a fan, though. It rattles away on a nearby table, surprisingly little air moving despite the racket, just enough to tease a few strands of hair from the top of his balding head.
‘Take a seat,’ he says. ‘Yellow folder’s just there.’
‘Thanks.’

I’ve come to give his daily Tinzaparin injection.
‘They showed me how to do it,’ he says, struggling to sit up, ‘…but when it came to it, y’know, to actually putting the needle in, I just couldn’t. My nerve completely went. So I’m sorry you’ve been dragged out to take care of business.’
‘Don’t worry about it, Ken. It was good of you to try.’

I chat to him as I get things ready.
‘I know what you’re doing,’ he says, tapping a finger on the side of his nose. ‘You’re taking my mind off what’s coming next. I know all the tricks.’
‘Yeah – but the other thing is I’m actually quite nosy.’
‘You’re in the right line of work, then.’
‘I suppose so.’
He tells me he’s originally from Warwickshire.
‘That’s a beautiful county,’ I say. ‘Sharp scratch.’
‘It is,’ he says. ‘Ouch.’
‘Sorry, Ken.’
‘No need to apologise. You’re doing a grand job.’
‘There! All done!’
‘Not too bad,’ he says, a little subdued, rubbing the spot on his abdomen. ‘These days I feel like a bloody pin cushion.’
‘I went to Statford-upon-Avon for the first time a couple of years ago,’ I tell him, popping the used needle into the sharps bin. ‘I thought it was an amazing place.’
‘It is an amazing place,’ he says. ‘It’s where Shakespeare was born.’
‘Yep. We did the usual things. Went round the house. Saw a play at the theatre.’
‘He was definitely what you might call a genius,’ says Ken. ‘I don’t think that’s too strong a word. Some people are clever, like, but he was in a whole other league. Have you seen pictures of him, with his forehead bulging out like that, like a bloody balloon? That must’ve been the pressure of all them brains. And the thing was, it all come from nowhere. His dad was some kind of businessman. I don’t know what his mum did. And suddenly they have this kid who’s writing all these poems and plays all over the place. Amazing, when you think of it.’
‘It is.’
Ken laces his fingers across his belly and watches me write in silence for a while.
‘What would-a happened to me, in the past, like?,’ he says eventually. ‘Before all these injections?’
I shrug.
‘I don’t know, Ken. Maybe nothing. But I suppose people didn’t tend to live so long in the past, did they? I mean – look at Shakespeare. He was dead by the time he was fifty-two.’
‘I ‘spose. I’m not sure how much good it does any of us, all this jabbing and poking, all these whatnots, these pills. It’s just dragging it out. I mean, take my old mate, Bill. Not the Bill you’re thinking of, another one. He weren’t that old when his kidneys packed up. So every other day he had to go to the hospital to be plugged in to a big machine that rinsed ‘em out and kept him going a while longer. I said to him, I said Bill! Is it worth it, mate? Wouldn’t it be better to let nature take its course? So he came off the machine and he was dead by the weekend. I said to the doctor, I said Did you give him a kick, to make sure? And the doctor give me a look like this…’
He widens his eyes, straightens his mouth and leans towards me out of the chair. Then after a funny kind of pause, relaxes back again.
‘Didn’t bother me,’ he says. ‘Everyone’s entitled to their own opinion. But by Christ! It ain’t half ‘ot today…’