Andre the Nurse

The flat we want is actually round the corner, on the front. Parking there is impossible, so I arrange to meet Andre the nurse outside the Chinese restaurant in an adjacent side street. There’s no time for much conversation; a squall of rain is sweeping in off the sea – so fierce it almost tears the boot from Andre’s car and empties the contents – all the dressings and folders and so on – out into the street. People squeal as they pitter past us, holding bags over their heads, wrestling with umbrellas turned inside out.

‘Let’s go!’ snarls Andre, and we run.

Andre the nurse reminds me of Andre the Giant from The Princess Bride. Not so much in height, although he is pretty tall. It’s more in demeanour, the same lunkishly, lowering kind of look. An ogre in a nurse’s tunic. Andre is basically harmless, though. I’m sure he could spend many happy minutes stroking a dove’s head – if a dove was ever dumb enough to land on his outstretched paw. And if it survived the stroking, and flew off in a dazed and crooked line, I’m sure the dove would feel affectionately towards him, too.

We’ve come to visit Rick, a patient referred to us by the GP, more as a welfare check than anything else, and to see if our team could help out in any way, with care or therapy or nursing and so on. ‘At risk of unconsciousness or death’ the referral had said, bleakly.

‘We’re ALL at risk of that, my friend!’ snorts Andre, buzzing the intercom half a dozen times, and then banging on the main door with the edge of his fist, with such brutal energy you’d think it was a SWAT team calling rather than a nurse from the hospital.

There’s no reply, just as there was no reply from the patient’s phone. Andre seems ready to pick up the block and shake Rick out, but luckily a delivery guy turns up with a code to get in, so we tailgate the rather anxious looking guy and then trudge up the plush steps to the third floor, grumbling about the weather all the way up.

Once we find Rick’s flat, Andre bangs on the door with such force the whole thing jumps in its frame.
‘Nurse!’ he shouts, which would have any sane person leaping from the bathroom window.
I look through the letterbox. The flat is silent, everything under sheets, buckets and paint trays and rollers on the floor.
‘I think it’s being refurbished,’ I say, straightening up. ‘He must be somewhere else.’
Andre sighs, goes to the flat next door and bangs on that, too.

Amazingly, an elderly woman opens it.

‘Oh – so sorry to disturb you,’ says Andre, using a whispery tone of voice so sinister the woman visibly recoils. ‘Me and my esteemed colleague are nurses from the hospital,’ he says. ‘I wonder if you would be so kind as to tell us where Rick is, please?’
The woman shudders, shuffles back in alarm, slams the door. There’s the sound of several bolts being thrown, a chain rattling on. Maybe a small wardrobe dragged into position.
‘Thank you so much!’ says Andre, giving a little salute to the door, then glares at me like I’m somehow responsible.
‘I’ll ring the office,’ I say.
‘You do that, Jimmy,’ says Andre. ‘Meanwhile I will stand here and think about why God is punishing me like this.’

The coordinator sounds sleepy.
‘Yes,’ she yawns. ‘The address is wrong. He’s in a flat on the other side of town.’
She texts us both the new address. Andre stares down at his phone as if he can’t decide whether to put it in his pocket or on the floor so he can stamp on it.
‘Come on, Jimmy!’ he says, choosing the former. ‘We can’t stay here the rest of our lives.’

The squall has settled into something more terrible, a hybrid inundation somewhere between a hurricane and the Great Flood. Even with the wipers on full it’s difficult to see where I’m going. It gets so bad I could be persuaded I’d left the road completely and was driving along the sea bed, following a whale that fails to indicate when it turns left. More by luck than skill I end up outside the alternative address; Andre parks in front of me and we both run with our coats over our heads to the entrance to the flats, a battered black door with a font of water rushing out of a broken downpipe across the pavement and over our shoes.
Andre beats on the door.
‘Come on! Come on!’ he says.
Just before we have to stop knocking and start treading water, the door opens and Rick stands there, his long hair matted, his beard worse.
‘Yes?’ he says, holding on to the door, then resting his face against the edge of it. ‘Can I help you?’
‘We are nurses from the hospital. Can we come in please?’
It sounds like Andre’s asking for sanctuary, which in a way, of course, he is. Luckily it seems to work. Rick releases his grip on the door and drifts back into the flat.
‘Your doctor asked us to visit,’ says Andre, shaking his coat and slapping the rain from his bald head. ‘Your doctor is worried about you.’
‘Oh?’ says Rick. He trails further back into the flat, sits on something that must have been a sofa once, and starts rolling a cigarette. He’s surrounded by empty cans of lager, and I’m impressed he managed to sit down without disturbing any of them.

Andre drags a stool over and tries to explain the reason for the visit, growling through the basics with the patience of a WWF wrestler called ‘The Nurse’. Rick is oblivious, though, fastidiously licking the strip of gum on the cigarette paper, rolling it, admiring it, then lighting it with the snick of a match.
‘Yes?’ he says, blowing smoke. ‘Er-hmmm.’
‘So this being the case, would you be accepting of such help from us, please?’ says Andre.
‘No,’ says Rick, picking strands of tobacco from his lips. ‘No, I would not.’
‘Do you understand what I am telling you?’ says Andre, almost tearing the folder in half.
Rick sighs, hooks the hair from his eyes, and – strangely – closes them when he looks at Andre
‘Like I said, officer,’ he says, ‘I’m perfectly fine.’
‘Okay. Good. You are perfectly within your rights to refuse, my friend,’ says Andre, trembling from the effort of control. Would you be so kind as to sign here, then?’
‘What’s this?’
‘This? This is a form to say that you do not want any help from us, and that you understand the risks involved in not accepting help,’ says Andre, handing him the paper and tapping with his pen where he wants Rick to sign.
‘What risks?’
‘Unconsciousness and death’ says Andre.
And the way he smiles at Rick, it’s like he doesn’t mind which.

the guru comes back

It’s so hot it feels as if the sun has dropped in closer and burned away every last scrap of moisture. I’m okay though – waiting for the social worker in the shade of the tall privet hedge that marks out the perimeter of this estate. I don’t mind the wait. I stand with my bags at my feet, waving to the people coming and going along the driveway. The postman in his foraging cap with a strip of blue canvas hanging over his neck; the young couple striding out with a pram covered in netting; an elderly woman with her shades flipped up, her permed hair glinting metallically in the sun. It starts to feel strange, like I’ve been standing like this for years. When the postman comes out again I half expect him to come over and hand me a letter: To the Man by the Hedge. ‘Dear Standing Man…’

Liam the social worker hurries across the road, hugging a battered leather briefcase to his chest, looking right and left over his shoulder like he’s escaping with secrets and expects to be shot.

‘Phew! Sorry I’m late!’ he says, striding towards me over the lawn. ‘Have you made contact?’
‘No. I thought I’d better wait.’
‘Good. Good,’ he says, pushing back his long hair, the sweat standing out on his forehead. ‘Well, then. Shall we…?’

Nanette’s daughter Roo answers the door.
‘Thank you for coming,’ she says. ‘Although quite what you’ll be able to do I don’t know.’

It’s a difficult scenario. Nanette was discharged home after some disagreement amongst the clinicians about her mental capacity. Nanette has chronic health problems, made worse by a recent infection. Her history of taking medication is patchy to say the least; she prefers to take herbal remedies, to meditate and follow a strict dietary regime – all of which is fine, of course, except it’s reached the stage where it’s difficult to say whether the progress of the illness is affecting her ability to make rational decisions about her health. She was so unhappy and disruptive on the ward, the hospital took the view that on balance she’d be better off at home with the support of community health teams.

None of this would matter so much if Nanette wasn’t suffering, and putting herself at considerable risk.

‘She was outside last night in the early hours, knocking on random doors asking for ice cream,’ says Roo, taking a steadying breath. ‘I live miles away. I just can’t be here all the time.’

What makes it even harder is that Nanette won’t accept any care support. She’s been turning people away, shouting at them through the window, telling them to piss off, and worse. The self-neglect is starting to show now. I’ve been sent in with Liam to do as much of a review as she’ll tolerate, to see how she is and what more can be done short of sectioning.

We put on our masks and gloves and follow Roo up the stairs.

Nanette is sprawled on the sofa. Emaciated, a dump of stringy limbs loosely wrapped in a threadbare dressing gown. The tiny flat is super hot; the little fan turning its head ineffectually right and left and back again, like a sad little robot saying no, no, no.

‘Hello Nanette!’ says Liam, giving a little nod. ‘I’m Liam, a social worker, and this is Jim, a nursing assistant. We’ve come to see how you are.’

‘Well now you’ve seen me so you can piss off,’ she says.

‘We’ll go if you want us to, but first we’d like to see how things are and how we can help.’
‘You can see how they are,’ she says. ‘They’re hot.’
‘I know. It really is hot today,’ says Liam. ‘Would you mind if we sat down over here and had a quick chat. We won’t keep you long. Promise.’
She shrugs.
‘If you must,’ she says.

Roo fetches in two small, brightly coloured stools, the kinds of things you might find in an infant school. We sit with our knees up to our necks, and try to smile with our eyes over the rim of our masks.

‘Would you mind if I did your blood pressure and so on?’ I ask her.
She sighs.
‘I’m fine!’ she says. ‘Why is everyone so obsessed with blood pressure? This is what’s wrong with the world. Haven’t you got anything better to do?’
‘Not at the minute. We’re here for you.’
‘Well that’s nice,’ she says, not meaning it. ‘Go on then. But don’t pinch.’
I run through her obs, which are surprisingly good, considering.
‘Thank you!’ I say, sitting back down on the stool. ‘That’s all fine.’
‘I told you! You won’t listen. There’s nothing wrong with me. And if there is, I cope with it my own way…’
‘Who’s that in the photo?’ says Liam, nodding over to a large, gold-framed, hyper-colourised photo of an Indian man in yellow robes, a string of flowers round his neck. He’s holding his hands out, palms-up, smiling so widely his eyes are creased shut.
‘That’s my guru,’ says Nanette. ‘I followed him for years. He died a little while ago.’
‘I’m sorry to hear that,’ says Liam.
‘Dont’ be,’ says Nanette, painfully pushing herself up on her elbows. ‘See that other picture, there? The one to the right?’
In a silver frame. A shaky, grainy, long-distance shot of a young Indian guy in white robes, striding onto a stage in front of a huge audience.
‘He came back,’ she says.