palliative patient

the hospice cat

~ jim clayton ~ Leave a comment

Mac is sitting on the balcony, smoking a cigar. It’s so bright when I step out to join him I can barely open my eyes. We don’t shake hands because of the virus, and I’m careful to keep my distance, but even as we make the usual jokes we both know the strange quirk of this situation. It would matter to me if I caught C19, but not really to Mac. He’s been sent home to die, with a prognosis of ‘weeks’.

‘What a view!’ I say, sitting down on one of the wicker seats opposite, shielding my eyes.
‘I’ve missed it so much,’ he says. ‘I was going a little crazy back in that hospital.’

I’m not kidding about the view. The balcony overlooks a busy port area, stacks of lumber, pyramids of gravel, warehouses, through-ways, the deep waters of the quayside in contrast to the silvery-grey ocean on the other side. It’s eerily quiet, though. All the cranes and forklifts are parked up. No people, no ships. The pandemic has cleared the place. Even the seagulls look uneasy, gliding past, wondering where the change is, what it means.

I’ve been asked to find out what Martin needs immediately, with the longer-term palliative teams to follow. I was a little nervous coming to see him. It’s never clear from the documentation just exactly what the patient knows or has accepted about their diagnosis. You have to tread carefully, feeling-out the right approach. Martin makes it easy, though. From the outset he’s able to talk freely about the treatment options that gradually closed off to him, the hard decisions, the plan as it currently stands.

‘I don’t need anything for the minute,’ he says, blowing out another, luxurious cloud of smoke. ‘I’m getting by, taking it as it comes. I know it’s going to get harder but for the minute I’m alright.’
I tell him how the service works, how quickly we can get back in touch if anything changes.
‘We’re just on the end of the phone,’ I say. ‘A couple of hours and we’re back.’
‘That’s good to know,’ he says.

His family join us. We sit in a semicircle, squinting out over the silent dockyard.
‘They asked me whether I wanted to go to the hospice,’ he says. ‘But – n’ah! I’m not there yet. Maybe it’ll come, maybe it won’t. I’m not sure.’
‘You could stay at home, if you wanted,’ I tell him. ‘We’d have to change things round a little, nearer the time. Put in a hospital bed. Other stuff. It’s up to you. It’s so lovely here. And you’d have the nursing teams coming in to support you.’
‘Everyone’s been so good,’ he says.
‘But the hospice is always an option, too.’
‘I mean – it’s a nice place and everything,’ he says, leaning forwards and carefully knocking the ash from his cigar against the edge of the ashtray. ‘I went there for a bit a little while ago.’
‘What did you think?’
‘They even had a cat wandering about the place. The way they treated him, you’d think he was one of the consultants.’
‘Yeah! I’ve seen that cat! He’s hilarious!’
‘If you like cats. Which I do. No – I’ve got nothing against the place. But it’s just – I don’t know. You get chatting to the geezer in the next bed, and you think you’re dying. And the guy opposite. And the guy next to you. Stuff like that. It can really freak you out.’

He takes another toke on the cigar. A lone seagull wheels and turns overhead. And in the near distance, and further away, the waters around the dock, the sea running out to the horizon, every last plane and detail of it – everything – it all just crackles and jumps with light.

calamity june

~ jim clayton ~ Leave a comment

I ring Albert to ask if it’s okay to come round and see him. When he picks up I wait for him to say hello or something; when he doesn’t, I say hello instead – but then he talks over me, pretending to be an answer machine:
I’m sorry we’re not here to take your call, but quite frankly, we couldn’t be arsed. So if you’d like to leave your name and number and what you had for breakfast, then – please – do that, but don’t hold your breath for a reply, because quite honestly you’re not going to get one. Thank you very much, and goodbye…
I hear his wife June in the background saying Who is it, Albert? – a scuffling sound as the phone gets handed over – then: Hello? Who IS this?
‘Hi June. It’s Jim, from the hospital. I came round to see Albert the other day.’
‘Yes. Hello. Sorry about that. Albert does like to muck about.’
‘He probably thought it was a nuisance call. The number comes up as private.’
‘We get a lot of that.’
‘Me too.’
‘So what do you want?’
‘Is it alright if I come over and do Albert’s blood pressure again? The GP wanted a few days’ worth…’
‘That’s fine. Come over. It’s not as if we’re going anywhere.’

*

‘Sorry about earlier,’ says Albert, answering the door and shaking my hand. ‘I get a bit carried away sometimes.’
June is standing behind him, leaning against the doorway to the kitchen, wiping her hands on a tea towel.
‘I wish you would get carried away,’ she says.
‘Hark at that’ says Albert.
‘Well I thought it was great!’ I tell them both. ‘I always swear I’ll say something clever or weird next time we get a nuisance call, but of course I never do. I always end up saying Please don’t ring here again. Which is so pathetic it practically guarantees they will.’
‘I’ve had a lot of practice,’ says Albert. ‘I’ve always been a bit of a clown.’
‘Is that what you call it?’ says June.
Albert shakes his head, then turns and walks unsteadily to his favourite chair, lowering himself into it with exaggerated care. June follows behind, perching herself on the arm of the settee opposite, whipping the tea towel over her shoulder, then folding her arms. It’s difficult to figure June out. She doesn’t smile easily, and when she speaks it’s clipped and to the point. It’s understandable, though. The strain must be awful.
Albert and June are a retired couple in their late seventies. June is as fit as you could hope to be – as rootin’ tootin’ as Doris Day in Calamity Jane – but Albert looks twenty years older. He has a palliative cancer diagnosis, and he’s becoming frailer day by day. Symptomatically Albert’s steady, functioning at a reasonable level, the pain controlled pretty well, but the prognosis is bleak. It’s impossible to say when he’ll enter the End of Life phase. One month, six months, a year, two…. I’m not surprised June has her pistols drawn.

I run through the observations. At every point, Albert makes a joke. When I put the tympanic thermometer in his ear (The light’ll come straight out the other side); when I count his pulse (So I’m not dead yet?); when I pump up the cuff to do his blood pressure (Jesus Christ! You’ll have my arm off at this rate); when I scratch his finger for his blood sugar (That’s very nearly an armful).
June sighs heavily each time.
‘Just let him do his job,’ she says.
‘There! All done!’ I say, packing my stuff away.
‘A-one back to the front!’ says Albert.
June fold the tea towel into a square and smooths it flat on her knee.

When I’m ready to go, Albert insists on seeing me to the door. When he gets there, he turns and leans against it.
‘Can you give me some advice?’ he says.
‘Of course. What about?’
‘I don’t want my family coming round any more.’
‘Why?’
His chin starts to tremble. He takes a breath to steady himself, then raps his stick on the carpet a couple of times, summoning the will to speak.
‘I don’t want them seeing me go like this,’ he says. ‘I want them to remember me as I was. So what would you suggest I do about that, hmm?’
‘It’s hard,’ I say. ‘I know what you mean. But I think anyone who loves you would want to see as much of you as they could. I know I would. I think they’d find it hard staying away.’
‘Well. There we are,’ he says. ‘Thank you.’
I give his shoulder a squeeze.
‘Come and sit back down, Albert. I worry about you.’
‘I’ll be alright. I’ll keep on my feet if you don’t mind.’
‘Okay then. You take care. I’ll let the GP know what your facts and figures are.’
‘Thirty-eight, twenty-four, thirty-six,’ he says, then takes out a hankie and blows his nose.
June comes over and leads him back to his chair.
‘Close the door on your way out,’ she says.

making faces at the fishes

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Hans seems too full of life to be dying of cancer. With his bald head, handlebar moustache, fierce expression and thick wrists, all he needs is a leopard skin tunic and he’d be a cinch for a circus strongman. As things stand though Hans is confined to bed, his lungs corrupted with secondaries, metastasizing like acquisitive weeds from the seed pod of his liver. When Hans talks he has a curious habit of repeating certain phrases at double the volume, and sitting up a little at the same time. It’s a funny thing, like a verbal sneeze. I guess he’s done it all his life, because his wife June doesn’t seem to notice.
‘I cannot believe zis thing,’ he says, his German accent somehow adding to the strongman effect. ‘I cannot! Y’know? Listen. Just the other month I was swimming in the sea in Spain. In Spain! Making faces at all the little fishes there. Now look at me. Hopeless. Hopeless.’
June is putting a brave face on it, though – her and the family dog, Boney, a bichon frise made entirely of clouds, who sits by my bag and frowns anytime I take something out.
‘What do you make of it, Boney?’ she says, brightly.
‘Well – vat can the poor dog make of it?’ says Hans. ‘Apple pie? I say apple pie?’

the last bid

~ jim clayton ~ Leave a comment

margaret sits in the flickering gloom
cancerous queen of the old front room
presses a B&H to her lips
watching antiques road trip
I think that wonnacott’s such a wheeze
she says, nodding at the little TV

margaret worked for the HMRC
(she didn’t want to confess it to me
because people can be seriously off
when it comes to money and all that stuff)
she says she was in her element there
up to her elbows in people’s affairs

margaret nursed her dying mother
endless nights watching TV together
blind date, ruth rendell, mr bean
furosemide, ramipril, mirtazapine
she’d never have believed it if you’d said
one day she’d be the one in bed

margaret takes one last long drag
then carefully grinds out her fag
as wonnacott models a regency muff
and worries if it’ll earn enough
she shakes her head and sighs
wonders when the woman died

margaret has her things to hand
remote control, juice and contraband
cheerfully waves me out the door
as wonnacott paces the auction room floor
and the muff bottoms out on the closing bid
and the gavel comes down on eighty quid

the end of the line

~ jim clayton ~ Leave a comment

Eamon is too tall for the recliner, his pale legs extending beyond the foot rest, so that his slippered feet hang in mid-air.
‘We need to get you some support there, Eamon. It’s putting pressure on the backs of your legs.’
Eamon turns his face to me, the waxy skin taught across his cheekbones. And whether it’s the cancer, the opiate medication, the distress of his decline, or a combination of all of these things, but he smiles in an off-centred way, like someone trying to make sense of a dream.
‘I’ve always been tall,’ he says.
I improvise an extra footrest from a packing crate and cushion, then finish the rest of the assessment, writing a long list of all the people I need to ring. I’m frustrated that Eamon was discharged without everything in place, but the wards are impossibly stretched, I don’t know all the facts, and anyway, I haven’t got time to worry about things I have no control over.
‘Can I get you anything?’
‘A cup of milk,’ he says, and looks down at a little porcelain cup on the cantilever table by the chair. I take the cup into the kitchen, rinse it out, then open the little fridge under the counter. There’s a huge, six pint carton of full fat milk in the door, a couple of microwave meals, a punnet of strawberries, and not much else. I pour him some milk, take it through and carefully hand it to him.
‘Ahh!’ he says, holding the cup with both hands. ‘Yes!’
Eamon’s chair faces a sash window that overlooks the backyard. In the yard is a clothes line with two white pillowcases gently stirring in the breeze. The sun is directly overhead now, and it blazes down on the linen, giving it a transcendent, brilliant quality.
‘I worked on the ferry,’ he says, staring at the washing line. ‘Then I left to nurse my parents. And here I am.’
‘I’ve always liked ferries,’ I tell him. ‘You really feel like you’re going somewhere. I remember we took the ferry back from France once and it was great. We had a cabin, and I was so exhausted from the long drive I just lay on the bunk and stared out at the sea…’
I almost say that it felt like dying and going to heaven, but I stop myself in time.
He nods, as if he knew that, then shakily swigs down the last of the milk and hands me back the cup.
It’s a small backyard with a limited space at the top between the buildings. The sun has moved only a fraction, but it’s enough to alter the angle of light so the line is now in shadow.
‘Can I get you anything else?’ I ask him.
‘No,’ he says. ‘Thank you.’ Then gently resting his hands back on the arms of his chair, he directs his attention to the window again, the washing on the line, and everything beyond.

circa 1966

~ jim clayton ~ 3 Comments

I don’t wan’ tae appear ungrateful
but I wish you’d all just sod off
You don’t need to tell me I’m ill
– I mean: Look at the state o’me!
dragging my sorry seln’ around
roped to this machine
like an old goat to a tyre
everyone too sentimental
or squeamish – or busy, no doubt
to break out the shotgun shells
and put one in tha’ back o’me heed
I mean – come on, son!
Who’re we kiddin’ here?
The thing is – it’s bad enough
losing ma’ freedom like this
getting dragged off to hospital
at a moment’s notice
hanging around on a trolley
while some fifteen year old doctor
hums and harrs and scratches
the fake wee beard he got fer christmas
lookin’ everywhere but straight in ma’ face
don’ bother, sunshine
I know what day o’ the week it is
I know what my lungs are like
C’mon in, number eight, your time’s up
No – what’s worse is a hundred people
I’ve never seen before in my life
traipsing through the house
like there’s no front door
saying ‘Hello Janet How are you Janet’
when I’ve never clapped eyes on them in me life
It’s like I don’t live here na’ more
I feel like sayin’ ta them:
‘Janet’s gone, mate.
She fucked off back to Glasgow
circa nineteen sixty-six
you’ll have to deal with me instead.’

technical glitch

~ jim clayton ~ Leave a comment

The rush hour has a hectic, drawn-down feel, people hurrying home through the damp streets, clutching their collars against the rain, struggling with umbrellas, the headlights and brake lights of the traffic around them fitfully illuminating the wintry October night.

Arthur is our last assessment for the day. If we’re to be off on time we’ll need to be quick, but so far at least, the omens aren’t good.

To begin with, we just cannot find the damned house.

I’d spoken to his wife June just half an hour ago to let her know we were coming. But now when I try to call her to ask where on earth thirty-eight South Road is, the phone is permanently engaged. We park up outside the block which, on the Satnav at least, bears the flag. There’s a man sheltering in the doorway, smoking a fag. When I ask him for directions he shrugs and taps some ash off to the side, carefully holding the fag cupped in his hand to shield it from the rain.
‘Is that a flat somewhere, maybe?’  he says, shuffling from side to side, glancing beyond me down the street. ‘Dunno, mate,’ he says. ‘Can’t think.’
We go round him, into the offices of what turns out to be a parcel delivery company. The receptionist behind the desk is bright and helpful, determined to find out where number thirty-eight South Road might be.
‘Sorry to bother you..’ I tell her.
‘Not at all,’ she says. ‘Happy to help. One…. moment….’
She taps around on the computer.
‘Oh! Apparently this is thirty-eight!’ she says, setting back and blushing. ‘Sorry – I only started here yesterday.’
‘So – do they live upstairs, then?’
‘No. Maybe. I’m not sure. I thought that was just a storage area.’
The manager comes through – slowly, as if he’d been hiding round the side of a screen and was reluctant to reveal he’d heard the whole thing. He stares at us neutrally as the receptionist explains who we are and what we’ve come for. No, he says. This is sixty-eight. And no, there isn’t an elderly couple living upstairs amongst the boxes, not as far as he’s aware.
‘I’m sure I would’ve seen something,’ he says. ‘Some nibbled cardboard, maybe a hat. But anyway – let’s have another look on the computer.
We huddle round another laptop as he opens Google maps. It seems a bit weird, going into street view for what is effectively the area just beyond the window, but it’s nice of him to try, and so long as June isn’t answering, I can’t think what else to do.
‘Here we are…’ he says.
He zooms in, but unfortunately, a huge truck had been passing the day the Google mapping car drove down South Road, so we’re unable to get any further with that.
‘Not to worry,’ I tell him. ‘Thanks for your help.’
I’m aware of them standing side-by-side at the counter, following us with their gaze as we hurry out into the rain.

Back in the car I try calling June again. This time she answers.
‘Oh,’ she says. ‘Everyone has this problem. I bet you followed your satnav, didn’t you? What the machines don’t seem to realise is that South Road actually starts beyond the traffic lights.’
‘Does it?’
‘Yes! We’re tucked away up here, but that’s how we like it.’
We leave the car parked where it is, because to move it would mean driving all the way round the one way system, which at this time of day would take forever. By the time we reach the front door, we’re both soaked through.
‘Oh dear!’ says June. ‘Is it raining?’
She shows us in to the narrow hallway, where we take off our coats and shoes and go through to a modest sitting room. The house has electric lighting, the sockets and switches so old the electricians who screwed them into place were probably tutting about the Suez crisis.
June is content, though. She sits by the fireplace, as immaculately pearled, coiffed and cardiganed as a minor royal.
‘He’s upstairs in bed,’ she says. ‘Although I don’t suppose he’ll be terribly pleased to see you. What exactly is it that you want to do with him?’
‘We’ve been asked to come in by the care agency to do a bed assessment,’ says Beatrice, the OT leading the assessment. ‘The carers say that the one Arthur’s in is too low, especially with his reduced mobility.’
‘He can hardly stand,’ sniffs June. ‘He’s pretty frail, you know.’
‘Exactly. We want what’s best for Arthur, but at the same time we have to be mindful of the health of the people looking after him.’
‘I know that,’ says June. ‘I know that very well. I’ve got arthritis as it is. It’s not doing me any good, bending down all the time.’
‘Absolutely.’
‘It’s just he’s such a stubborn old so-and-so. I can’t see him agreeing to a hospital bed.’
‘I think we have to try, though, June. Otherwise we’ll just run into more problems further down the line.’
‘Well. If we do, we do.’
‘Shall we go up and introduce ourselves?’
‘I’ll show you the way,’ says June, getting up with some difficulty. ‘Just don’t expect me to run there.’
The staircase rises steeply, past the first floor landing, winding on and up into the gloom of the upper storeys. I’m glad Arthur’s bedroom is on the first floor though, as getting this far has taken a fair while, June struggling to make the climb, putting her good left foot up first, then hobbling up with the right, sliding her hand along the rail, pausing for breath, and then repeating the process again. The nearer we get to the landing, the more distinct is the noise of Arthur’s oxygen machine, whirring and clicking beneath a large, foxed print of Napoleon’s retreat from Moscow.
‘He’s through there,’ puffs June. ‘You go on.’
The notes had described Arthur as a palliative COPD patient, not quite end of life. The ‘not quite’ is a surprisingly optimistic qualifier, certainly from where I’m standing. The ravages of his respiratory illness combined with his extreme old age have left him cruelly stripped of anything resembling flesh. His hands lie outside the covers, and it’s astonishing to see their complex mechanism laid as bare as an anatomical model: the tendons, the ligaments, the veins.
It’s a shock to see him open his eyes.
‘Oh,’ he says. ‘And what do you want at this ungodly hour?’
‘It’s half past six, Arthur’ says June, finally making it into the bedroom and sitting down on a rattan chair that creaks dangerously.
‘Yes. I know. Half past six in the morning.’
‘In the evening’
‘The evening? Have I really been sleeping all day?’
‘Yes, Arthur. You have’
‘Well, I humbly beg your forgiveness, one and all,’ he says. ‘I find my rather straightened
circumstances are not conducive to keeping a proper track of the time.’
‘No worries!’ says Beatrice.
‘I have this marvellous electronic watch, d’you see?,’ says Arthur, slowly lifting up his left arm.  An old Casio digital watch slips down almost to the elbow.
‘Unfortunately it seems to have stopped working,’ he says, gathering it back up to his wrist, and then relaxing his hands back on to the covers. ‘Once upon a time it used to beep’
The business with the watch seems to have exhausted him. His breath comes in and out through his slack mouth, making a dull whistling noise.
The carers were right to be concerned. Arthur is more or less bed-bound, on a low single divan in the corner of the room. I can’t imagine how you would go about washing and cleaning him, creaming his pressure areas, changing his pyjamas. Even sitting him up to drink would be a struggle. When we’ve roused him again, Beatrice explains the situation with great courtesy and clarity, gently steering him in the direction of a hospital bed.
‘They’re very comfortable,’ she says. ‘You can change the position at the touch of a button, sit up to eat or watch telly, raise the mattress at the knee to ease the pressure on your legs, go up and down – whatever! They’re brilliant, really. And then your carers won’t have to worry about hurting their backs. Because if they do, Arthur, they won’t be able to come in and help you, or any of the other patients on their books. And I know you wouldn’t want that, would you, Arthur? Hmm?’
He slowly shakes his head from side to side, the oxygen tube riding up over his ears and back down again. Someone’s put a little scrap of tape on top of his left ear, to stop it rubbing.
‘No,’ he says. ‘I completely understand what you’re saying, and I thank you for coming here and saying it. But I’d really rather not be moved. I’d rather just be left here in peace for now, and everything else can wait. Thank you.’
We try a little while longer to persuade him to change his mind. In the end, though, the best we can manage is to arrange to come back the following day.‘It’s been lovely meeting you,’ says Beatrice, taking his hand in hers and giving it a squeeze.
‘Likewise,’ he says. ‘Only – when you come back – please, don’t make it quite so early in the morning.’

pushed for time

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I have an appointment at three o’clock, a double-up with an occupational therapist at the house of a patient discharged from hospital that day. But so long as everything falls into line, and the traffic is only slightly north of reasonable, and I manage to pare each visit down to the barest and most pragmatic interaction permissible by law, three o’clock is perfectly achievable.

Of course, it doesn’t work out that way.

The ECG machine decides to play up, in that almost supernatural way electrical equipment has sometimes of sensing your impatience and transforming it into pure cussedness. And when I try to draw blood from the second patient, I have as much luck as if I’d staggered out into the garden and jabbed the old apple tree. That, plus running into a horrible thickening of the traffic heading west, so inexplicably and uncharacteristically bad it makes me think I’’ve missed an emergency radio broadcast telling everyone to drop everything and clear the hell out of town – all this means that by the time I’m pulling up outside the house, half an hour late.

‘I -am-so-sorry!’ I say, piling in through the door with all my bags.
‘That’s okay!’ says Rick, the OT. ‘We’ve just been taking our time, going through a few things. It’s alright.’
Gil, the patient, is sitting forward on the edge of a sofa. His hair is dyed crow-black, back-combed in Gothic style, which only seems to accentuate the extreme pallor of his face, and the dark hollows of his eyes. Shaking his hand is like scooping a fragile bird into my fingers.
‘Pleased to meet you.’
‘Likewise’
I sit down on a low stool as Rick brings me up to speed. He gives me the discharge summary to look over, too, and I glance at it from time to time. I’ve already been told the basics – the alcoholism, self-neglect, the concerned neighbours, the intervention of the social work team and so on – and the fact that a deep-clean company had been brought in whilst Gil was in hospital. What I hadn’t been told though was the seriousness of his situation now. The discharge summary lays it all out in dry and technical language; beyond it, like seeing a dark and formidable landscape through a formal window, is the hard truth of the thing. Gil has come home to die.
‘If you want to get your bits and pieces out of the way whilst I finish this bit of paperwork…?’ says Rick, as I hand the summary back.
‘Sure! Why not?’ I say, grabbing my kit and going over to kneel by Gil. ‘Is that okay?’
He accedes to it all with a measured kind of passivity, smiling often, but in a gentle way, like someone who’s decided the only thing he can change about the destination is his understanding of the journey.
I don’t push anything. Just the basics. And when I’m done I shake his hand again, gather my things together and leave Rick to finish off.

Back outside, I’m throwing my bags in the boot of the car when an elderly man in a flat white cap, anorak and check shirt stops right by me. He holds a map book almost to the end of his nose, looks up and down the street, lifts his tinted glasses, presses the map book closer, squints, looks up and down the street again, and then takes his cap off and scratches his head. It’s all pretty emphatic,  like watching a modern clown doing a skit called Lost.
‘Are you alright there?’ I say.
‘Me? No. I’m late and I can’t be.’
‘Where’ve you got to get to?’
He brings the map over, hands it to me, then takes an envelope out of his pocket – something formal, a legal appointment.
‘Well don’t worry. You’re almost there,’ I tell him, handing the map book back. ‘Are you walking or driving?’
‘Driving? Me? No! I came by bus. The man there, he said get off here. He said here was where I had to be. So that’s what I did. And now I wish I hadn’t.’
‘He wasn’t wrong, though. You’ve just turned down too early. You want the one parallel to this, over there. You can cut through that little alley if you’re pushed for time.’
‘Are you sure?’
‘Yep. Absolutely.’
‘I can’t afford any more mistakes.’
‘You’re good,’ I say. ‘You’ll be fine.’
‘Righto then. Thanks for your help.’
He gives me a broad, quick smile that seems more like a mechanical expression of the tipping back of his head, then taps me once on the shoulder with the map book, and strikes out for the alley.