who wakes the lion?

Mrs Kerridge isn’t at all how I imagined her from the phone call a couple of days ago. Instead of a velociraptor in wig and slippers, shreds of flesh trembling from her teeth, I shake hands with a trim, short-haired woman in her sixties. Her smile does seem a little flat, though, like those masquerade half-faces on a stick – but to be fair, mine probably looks just as forced. We’re both doing our best.
‘Good to meet you!’ I say, holding out my hand.
‘You too!’ she says, shaking it.
‘Sorry for the confusion.’
‘Can’t be helped.’
‘No.’
We stand in the hallway, smiling, swaying slightly.
‘Lovely house!’ I say, shoving my hands deep into my pockets.
‘Thank you! We do try.’
‘Amazing.’
‘Yes.’

Greg, the equipment technician saves us, wiping his boots hard on the mat.
‘Mind if I check the lie of the land?’
‘Not all!’ beams Mrs Kerridge. ‘It’s going to be quite a house full!’

We go through to the living room where Mrs Kerridge’s father has been installed on a hospital bed. His mobility has deteriorated to the point where he needs a dynamic, pressure-relieving mattress, but because he’s non-weight bearing – and a hoist had been ruled out due to the distress it causes him – the only solution is to assemble the replacement bed and mattress next to him, slide him across, strike the old bed and then move him back into position. I’d tasked two of my colleagues to help with the transfer. They arrived in good time, and we stand around making chit-chat whilst Greg puts the new bed together.

Mr Kerridge snr is oblivious to the whole procedure. Opposite, half-way up the wall, is a large, flat screen TV. It’s currently playing a Zoo Vet programme. There’s a ventilated lion on the operating table, vets in scrubs standing around with their gloved hands in the air, like no-one wants to be first to start.
‘A lion!’ says Mrs Kerridge.
‘Imagine!’

For some reason, what it makes me think of is the last time I’d spoken to Mrs Kerridge. She’d rung the office to complain, and even though I didn’t know anything about the case and had had no contact, I was the only one available to take the call. She’d been furious, incandescent. There were a number of things that had gone wrong since her father had been with our service. Promises made and broken. Conflicting advice. Disruptive appointments. It was a list that spooled out furiously as I held the phone slightly away from my ear. And even though I had the patient record open in front of me, and tried as hard as I could to make sense of what she was saying, there was nothing I could come up with that would placate her. In fact, it was less of a complaint and more of an audio onslaught, a release of verbal steam, and the best I could do was lob-in the occasional I’m sorry to hear that or let me look into that for you. The advice in these situations is never to take it personally. The complainant feels aggrieved, so just hear them out, make notes, and resist the urge to promise to fix things that might only end up making the situation worse. It was difficult to bite my tongue, though. I could see from some of the narrative entries on screen that she’d been hostile in the past, refused help and then complained when it didn’t arrive, turned equipment away, and generally made life difficult for the therapists and clinicians.
‘I think there’s some sort of family rift,’ said Anna to me afterwards. ‘Best not go there. Once the bed’s in he’s open to the district nurses, so…’

Of course, it just so happened that the bed was late. There was a misunderstanding between the therapist who ordered it and the senior therapist who signed it off (it’s an expensive piece of kit). So the delivery date got bumped, and I was tasked to call Mrs Kerridge to tell her we couldn’t make the appointment but would be there the following day at the same time. I was fully expecting her to reach through the phone and throttle me, but it went to voicemail. I left a message. I heard nothing back. Everything was eerily quiet. The kind of quiet that falls on a lush rain forest in the lee of a volcano before it blows.

I was dreading the appointment. I’d volunteered to be one of the three, not just because I felt mean off-loading it onto someone else, but because I was curious to meet the woman who’d been so vile on the phone. What would she look like? How would she be? How well would I be able to withstand that kind of assault in person? It was something of a morbid fascination, like feeling drawn to the edge of a cliff to look down on the wild sea raging below.

But no. Here we are, perfectly calm, half watching Greg assemble the bed, half-watching a lion having its gall-bladder removed.
‘Amazing!’ I say to Mrs Kerridge.
‘I wouldn’t want to be the one who wakes it up, though. Would you?’
And she nods at me, and smiles.

a tumbleweed of barbed wire

If I was a comic I’d be dying on my arse. In a tiny, Thirties-themed, immaculately hoovered comedy club. Three people in the audience, two of them arms folded, stony faced, one of them smiling (the one with dementia).
It’s bracing, to say the least.

‘I’m not wearing a bra’ says the elderly woman.
‘That’s alright. Neither am I’
Tumbleweed.
‘Who are you again?’ says the son.

I’d been expecting an easier gig. I’d rung the first listed next of kin, a daughter called Louise. She’d been so chatty and friendly on the phone – sorry she wouldn’t be able to make it down today, she was caught up at the stables… not in a bad way… horses? who’d have them…. that kind of thing… but it was okay… her brother and sister in law would be over to meet me… thanks for ringing… thanks for everything, and so on.

Walking into the house was like walking into a wall. Made of ice.
‘So – what are you?’ says the son.
‘A nursing assistant.’
Assistant?’
‘Yes. Well – my official title is Assistant Practitioner. But everyone just thinks that means I’m a doctor. So I never call myself that – unless I’m ringing a surgery, in which case it helps get past the receptionist.’
Another tumbleweed. Probably the same one.
I can feel myself starting to sweat, even though the room is actually pretty cold.
‘Are you registered?’ he says.
‘No. But I’ve got a lot of experience, and the rest of the team are just a phone call away.’
‘I see.’
(I wish I was a phone call away. At the very least.)
‘What team?’ he says.
I describe the make-up of the response team. It sounds inauthentic, like I’m reading off an autocue.

I’m not sure which of them is tougher, the son or the daughter-in-law. It’s not good cop / bad cop. It’s bad cop / awful cop. I have a giddy, out of body experience, where my temporal body carries on talking, but my ghost unplugs, drifts over, raps on their foreheads, and finds – to no great surprise – they’re actually made of tin.

‘…so, we get referrals from the GP, the hospital or the ambulance, and we go in and annoy the hell out of people in the cause of making sure the patient is safe to be left at home.’
A tumbleweed the size of a small planet. I wish I could jump inside and roll away, like one of those big, plastic balls. Zorbing, is it? Geo Balls?

They’re staring at me.

I try to shake myself out of my funk and focus on the patient instead. That’s who I’m here for, after all. I have no idea why they’re being so hostile. It could be any number of reasons – they’re stressed to the gunnels about something, they’re annoyed they had to come out here instead of Louise, they’re angry with each other and taking it out on me, they’re terribly shy and it just reads as defensive – but frankly, I’m here for the patient, and anyway, she’s much warmer and more fun than they are.
I go through the usual routine of taking blood pressure and so on. I use all my best lines. The patient likes it, but Mr and Mrs Medusa just glare at me from the sofa.
‘I just need to take your hearing aid out so I can do your temperature,’ I tell the patient.
The son stands up.
‘Let me do it,’ he says. ‘They cost two thousand pounds.’
‘Thanks,’ I say. ‘I’m scared of those things.’
His wife snorts.
‘Don’t let him any where near them,’ she says, meaning her husband, thank god. ‘He left his in when he went for a swim in the sea.’
‘Oof!’ I say. ‘Apart from that – how was the holiday?’

A tumbleweed of barbed wire.

diving in

‘Just do what you can,’ Michaela the co-ordinator said. ‘It’s a tricky situation. Jeremy’s wife Serena has got dementia, Jeremy’s the main carer. The doctor says Jeremy has to go to hospital in the next few hours, something about his breathing. Apparently none of the rest of the family can step in, and Serena’s too volatile to go to a respite bed, so what they’re saying is she’ll just have to go to hospital with him in the ambulance. Which is a terrible idea, obviously. If you could just go there and try and sort something out that’d be great. You’ve got a couple of hours before the ambulance arrives. Good luck.’

* * *

When I lived in London I used to go swimming in the ponds on Hampstead heath. I’d try to keep it up as late as I could through the year, not just in the easy summer days, but on into October, November, December, when the weather drew down, and the crowds thinned, and the whole thing started to feel like a wanton act of madness to take my clothes off and walk outside the changing rooms into the frosty air, let alone walk to the end of the jetty and throw myself in the water. It didn’t matter how many times I stood there with my toes curling and flexing over the edge of the concrete, staring down into the dark green water; it didn’t matter that I’d done it only a few days before, and everything had turned out okay, I hadn’t drowned or frozen to death, and I’d even started to enjoy it, that electric buzz around my body when I climbed out and hurried back inside. Despite all that, the seconds before I dived in, I would still be gripped by the same sickening feeling that this was crazy, tantamount to suicide, and what I really needed was for someone to rush out, grab hold of me, and save me from myself.

* * *

I’m reminded of that end-of-jetty feeling as I reach out to ring Jeremy’s bell.

Anna, Serena’s tearful, middle-aged daughter, comes to the door, barely stopping long enough to hear me introduce myself before turning around and hurrying back into the living room. I stand in the oak panelled hallway and tried to get my bearings. A substantial house, with a large number of doors leading off into various rooms, and a forbidding staircase rising in the middle of it all. Elderly people are busy coming and going through the doors or walking up or down the staircase, each one of them preoccupied, mumbling or cursing to themselves, holding bits of paper or bags, a shirt, an overcoat, bumping into each other, shouting out – so many of them I’m suspicious, and wonder if it this isn’t some kind of set-up, and they’re swapping jackets or hats backstage, finding a different door or staircase to walk through or down again, like a manically paced but well choreographed West End farce.

Bracing myself, I go through to the kitchen where some of the relatives have gathered round the table with Serena at the head end. Serena has the quick movements and filmy white eyes of a large, albino crow, hopping from the table to the cabinets and back, randomly picking up bits of paper, blinking down at them uncomprehendingly, then carrying them back again.
‘Try to settle yourself, Serena’ says one relative.
‘Come on. Drink your tea,’ says another.
But Serena sees me approach and hops up to speak, as fluently as if we’d only broken off a moment before.
‘…you see, I can’t be bothered with all of this!’ she says, looking up into my face, tipping her head from side to side and blinking rapidly, as if she can’t decide whether to talk to me or peck me up like a worm. ‘It’s such a nuisance! I’ve got so much to do today. D’you see?’
‘Yes. I can imagine it must be pretty stressful.’
The relatives fix me with a collective frown.
‘Sorry! Hello! I’m Jim, from the hospital response team. They’ve asked me to come and see if there’s anything I can do.’
‘Well unless you’ve got a magic wand in that bag I’d say no,’ says one elderly man.
‘Or a tranquiliser dart,’ says another. ‘Welcome to the madhouse.’
Just then Jeremy wanders in. He’s a morose, red-faced man in pyjamas and dressing gown, trailing the cord of it behind him like a tail.
‘They’ll be here in a minute,’ he says. ‘What have you done with my medications?’
One of the relatives sighs and pushes himself up from the table. Another one appears briefly behind me in the doorway, then disappears just as quickly.
‘Come in to my study and we’ll chat there,’ says Jeremy.
I follow him, avoiding the tail.

Jeremy’s study is a plush room, like something out of a gentleman’s club, with brass fittings, spot-lit paintings, and antique rifles and muskets on display along the walls. Jeremy goes to sit behind an enormous desk, complete with green velvet pad and a crystal glass ink and pen stand.
‘You know the situation I take it?’ he says, putting some half-glasses onto the end of his nose and then tipping his back to look at me. ‘Hmm?’
‘Essentially – you have to go to hospital, but you’re Serena’s main carer and there’s no-one else to step in and look after her.’
‘And I mean no-one,’ he says. ‘She gets very distressed by any change, so it’s out of the question for her to go to a nursing home. I’ve told them this. Out of the question! And neither can she be left on her own. She’d burn the house down in a matter of minutes.’
‘How about arranging for a twenty-four hour carer?’
‘No,’ he says. ‘Any strangers in the house and she reacts. She’s very difficult. I’ve had years of it.’
‘The trouble is, Jeremy, going to hospital with you is the worst thing that can happen. You’ve been to A and E before. You know what it’s like.’
‘I know exactly what it’s like. It’s hell on earth.’
‘They do get very busy there, that’s for sure. And that’s why Serena can’t really go with you. She’ll be sitting in a chair for hours and hours whilst you’re on a trolley, surrounded by potentially distressing scenes. And there’ll always be the chance she might wander off…’
‘Well that’s it! I’m not going, then!’
‘The doctor thinks you should go, though. It won’t help Serena if you get worse, will it? So what I suggest is you look at getting a twenty-four hour carer to stay whilst you’re in hospital. They’re trained to look after difficult patients. She’ll be happiest and safest that way. It’s the best solution, Jeremy. I’m just being perfectly frank with you here.’
I can see him weakening.
‘But where would they sleep?’ he says.
‘I’m sure you could squeeze them in somewhere.’
‘And how much would it cost?’
‘I think it’s about twelve hundred for the week.’
‘One thousand two hundred pounds?’
‘I think so. It’s just a little more than a residential home would be – but you’ve got the benefit of Serena being at home in familiar surroundings, so she’ll find it much less stressful…’
He huffs and grumbles, pushing papers around on the desk a moment, then shoots me a look as directly as if he’d rammed the words into the muzzle of one of those muskets and fired them at me.
‘And who pays for all this? Me, I presume!’
‘I think it’s worth it. For peace of mind. And hopefully you won’t be in hospital long.’
‘Hmm. Well. Get me some actual figures, would you?’
‘Certainly.’

I phone the office to talk to a social worker about it. She rings me back five minutes later with the name and number of an agency who’d be able to step in at short notice.
‘I can’t pay up front,’ says Jeremy. ‘I’m good for the money as you can probably see but I’m waiting on a deal coming through. It’s complicated. A cash flow thing.’
‘Fine. I’ll talk to the manager of the agency and see what he suggests.’

The manager sounds cautious.
‘We want to help,’ he says. ‘Of course we do. But we need at least half up front as a gesture of goodwill. And then a guarantor of some description for the rest. It doesn’t look good for a care agency to be chasing down clients for money, y’know?’
‘No. I can see that.’
I tell him I’ll call him back after I’ve talked to the family. Back in the kitchen, one of them says he’ll stand for the other half. ‘ Anything to get this bloody mess sorted.’
In the study again. Jeremy says he can only manage a cheque for four hundred, and asks if I’ll haggle with the manager over that.
Meanwhile the ambulance arrives; two paramedics crash into the study carrying resus and obs bags and an ECG.
‘Where’s the patient?’ says the first.
Jeremy starts shuffling papers on his desk, avoiding eye contact.
The paramedics turn to look at me, holding the phone in the middle of the room.
Serena hops in, pursued by three relatives, one of them The Guarantor, who frowns at me and holds his hands out, palm up.
The phone starts ringing in my hand. I hold up a finger for silence.
‘Just give me a moment!’ I say. ‘One moment…’

next stop market street

All I’ve done is asked Ken to stand up for me. I’ve asked him as gently as possible, making it clear that I need to see for myself exactly what he can and can’t do.
‘Righto’ says Ken, and gets himself ready.
‘I’m not staying here to watch this,’ says his son, Barry. ‘I can’t be doing with all of this.’ And swiping his coat from the back of a chair, he slams out of the room. Barry’s wife, Jean, is equally tense.
‘I’ve told you. He can’t stand. If he could stand, he wouldn’t ‘a pissed himself in the chair. ‘Scuse my language. They’ve sent him home too early. He should never’ve been let out like this. They just don’t give a damn. All they care about is the beds and kicking people out. They don’t give no thought for anybody else.’
Meanwhile, I’ve put Ken’s zimmer frame in front of him and stood to the side, just in case he needs a hand.
‘Okay, then. Right, then,’ says Ken, and stands up.
‘Of course he does it for you,’ she says. ‘He’ll do it for a uniform. But how’s he supposed to manage when there’s no-one here? We’re supposed to be going away on holiday tomorrow. How’s he going to cope then?’
Whilst Jean is talking I’ve discreetly checked the seat of the chair, which doesn’t appear to be damp in any way.
‘Well that’s the next step,’ I tell her. ‘That’s what we need to find out.’
I rest a hand on Ken’s shoulder. ‘How do you feel about a trip to the bathroom?’
‘Oh, yes!’ says Ken. ‘Fine. I’ll give it a go, like. Y’know – I used to be a tram driver before the war. Next stop market street! Hold on very tight…’
‘Just concentrate on what you’re doing,’ says Jean.
‘Righto,’ says Ken.
He starts walking with the frame in the direction of the bathroom. He looks pretty steady, so I go ahead and clear some bags and things out of the way. He makes it there in good time, manages to turn round safely, lower himself onto the toilet, and get himself back up again.
‘That’s great!’ I say. ‘There are a few bits and pieces of equipment that’ll make it even easier, but I think you’re pretty good.’
‘You think so?’ he says. ‘Because I don’t want to be a bother to anyone.’
‘It’s no bother. Come on. Let’s get you back to your chair.’
Whilst I’m helping him back there, Barry comes back in, followed by a waft of smoke.
‘He’s only gone and got him to walk,’ says Jean.
‘Have you?’ says Barry. ‘Who the hell are you? Jesus Christ?’
‘Me? No. I’m his more talented brother.’

when the time comes

Margaret’s daughter-in-law Sandy is standing over by one of the bookcases, casting her eye over the spines, taking the odd book out and idly flipping through.
‘Quite what we’ll do with all these when the time comes I don’t know,’ she says. ‘I mean – it’s a shame. These Dickens might’ve fetched something, but the sun’s got to them and they’ve gone a bit foxy.’

It makes me feel uncomfortable, but it’s my own fault, of course.

I’d started setting up to take blood from Margaret, and Sandy and the two carers had been standing round the bed, saying nothing, just watching.
‘I’ve never had such an audience,’ I said, just to break the tension, because it didn’t really bother me whether I was observed or not. ‘Talk amongst yourselves.’
‘Sorry!’ Sandy said, and that’s when she started to walk round the room, pricing things up.

As it turns out, though, I’m glad the attention has switched to Little Dorrit. Margaret is quite poorly, and getting anything remotely viable is like trying to tap-up a strand of hair. I’m not even sure why I’ve been asked to try. Margaret has steadfastly refused hospital – and I’m completely with her on that. She’s in her nineties, for goodness sake. If I was her I’d be refusing hospital, too. The only thing I might do differently is ask them turn my bed around so I could face out into the courtyard garden and that flowering cherry, so vibrantly and abundantly pink it would gladden even a dying heart.

‘Alright?’ says Sandy, coming back over. ‘Getting any?’