schatz katze

The key safe is hanging open so I ring the bell instead. I step back and look up at the house whilst I’m waiting – a substantial Regency building, a little down-at-heel and cracking up, perhaps, but still impressive, with a wildly overgrown garden whose depths of shadow hint at stone baths and iron cold frames and other features utterly consumed with ivy.

The door opens and a bright, middle-aged woman in a carer’s uniform steps out onto the cracked mozaic tiles.
‘I’m so glad you’re here!’ she says, showing me in. ‘I think this is one for social services as much as anyone. I’m Karen, by the way!’

I stand with her in the hallway so she can tell me what she’s found so far. Helga is a ninety-five year old with no package of care and generally ‘bumping along the bottom.’ A neighbour looks in now and again. Found her on the floor, called the ambulance, hospital declined, referrals made. Karen points out a sheet of paper sellotaped to the mirror: In Emergency written in shaky green caps at the top, and below it, a handful of names and numbers, the nearest being Munich, the furthest, Hobart, Tasmania.

‘I feel so bad for her, says Karen. ‘There’s hardly any food in the house. Can I leave her with you whilst I nip round the corner and get the basics?’

Helga is lying in bed, stroking a black cat that’s sprawled on top of her, purring so loudly it fills the entire house. In an odd kind of way, it makes the place seem emptier.
I introduce myself, and explain why I’ve come. When Helga reaches out to shake my hand, her hand is so weak and light in mine it’s like the memory of a handshake that happened sometime just after the war.

I start to talk to her about the situation. How she’s feeling, how she’s been coping and so on, gently trying to tease out the facts. Helga doesn’t want to engage, though.
‘Ah! Too tired!’ she says, transferring her attention back to the cat with a philosophical pursing of the lips.
Was ist los?’ she says, feebly waggling her fingers under its chin. ‘Was ist los, shatz? Was ist los?’

character phones

Tony has a range of character phones. Tweety Pie, Hello Kitty, Bugs Bunny and so on. All of them bravely maintaining their expressions beneath the same grimy brown patina that covers everything in Tony’s room. It’s an astonishing thing, a dismal, bristling crust that wouldn’t look out of place on the wreck of a ship at the bottom of the Atlantic. And if this was a ship, I’d guess, through the visor of my mask, that I’d swum into the nursery, because encircling the whole room are three shelves, each of which is packed full of toys and childish souvenirs of every description: elephants, camels, teddy bears and finger drums, Chad Valley projectors and unidentifiable things in snow globes, figurines in decaying boxes from shows I’ve never heard of – the whole, mouldering cargo merging one thing into another, in one great soup of neglect.
‘Quite a collection you’ve got,’ I say as I take his blood pressure.
‘Inherited,’ he sniffs. ‘I had six relatives all die in the space of two years. I got rid of what I could. The rest just stayed.’
‘I’m sorry.’
‘It was a bad time that’s for sure,’ he says, rolling his sleeve down again. He coughs – such a sludgy sound it’s hard to resist the idea that his lungs are coated in the same noxious matter as the rest of the room. ‘I fell ill. And then my support worker died.’
‘How awful!’
‘He dropped dead in this room, right about where you’re standing now.’

you tell me

Charles, sleeping in a wing-backed chair
kippering by a two-bar heater
trousers sliding south,
hernia through an open shirt
like a burr on an ancient beech
or the head of an imp
in a breast-feeding nightmare
What d’you want? he says
his one good eye suddenly wide
like I tripped a wire somewhere
‘Sorry to wake you, Charles’
Hmmm he says, backing into his beard.
‘I won’t keep you long’
The room – oh! The room!
The room is a cliche of neglect
peeling paper – check
seamy bedclothes – uh-huh
everywhere that slow, sad laying-in of time.
Charles won’t agree to a thing, of course
not a temperature check,
pulse count or blood pressure
so I retreat to a plate
of tea and toast
and inconsequential chat
hoping that one word
will follow another
into something like acceptance
‘What did you do before you retired?’
handing him the mug
What do you mean?
‘You know. What work did you do?’
What work?
‘Before you retired?’
He lowers his face to the mug
and gabbles at the lip
like a goat invoking a curse
then, lowering it unsteadily again
to rest on the pate of his hernia,
he fixes me with that eye,
that furious, shining, ineluctable eye
I’m ninety-five! he shouts
You tell me!

clive’s familiar

Clive lives in a grotto
(portmanteau word: rotten, grot and odour)
there’s a foetid curtain hanging across the bottom of the stairs
that reminds me of those doors
you used to bang through on the ghost train
Beware! Horrors ahead!

Clive is not sitting in his armchair
so much as being slowly consumed by it
he’s smoking a fag, artfully balancing
a long and crooked stack of ash
with the wizened fingers of a mummified count
‘hello’ he says. ‘And who might you be?’

Clive doesn’t want any help, thank you
he’s quite happy as he is
he already has a heap of equipment
(toilet aid, perching stool, zimmer frame)
tossed in a bath that last saw water
when Nasser blockaded the canal

Clive has a cat on his lap, a placid brindle coloured animal
(though it’s perfectly possible that, along with everything else,
the walls, the furniture and me, probably,
it’s actually a snow white cat kippered by all the smoke)
‘He’s lovely,’ I say. ‘What’s his name?’
‘She!’ says Clive, losing his ash. ‘It’s a girl. And I call her Thingummy’.

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.

pushed for time

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.

a matter of life and death

I can see Jeremy through the window, sitting in an armchair in front of the television, his fingers laced across his bare chest, his eyes closed, the television bathing him in a flickering blue light. I watch for a moment, to make sure that he is actually breathing, and it’s not some animating trick of the light. But then he squeezes his eyes and wrinkles his nose, and adjusts the position of his head on the cushion. I tap on the window again.

Even though the screen is facing away from me, I can tell it’s an old David Niven film. That beautifully modulated, terribly sincere English accent. But you know, are you in love with anybody? No, no don’t answer that…

‘Jeremy? Jeremy! Can you come to the door? It’s Jim, from the hospital.’

He doesn’t respond. I knock again. When he seems to open one eye, I press my ID badge against the pane. It’s no use. He sinks back into what now appears to be a determined kind of sleep.

Not that I’m keen to go in. I’ve already been warned to wear shoe covers, and I can see through the window that the accounts of rotting food and piles of rubbish were no exaggeration. Anyway, even if I hadn’t seen the report, the windowsill would tell me all I needed to know. It’s littered with the husks of flies, lying on their backs with their legs crimped up, so large I’m guessing they just dropped from the air and died from sheer luxuriousness, whilst around them, hyperactive amongst the webby detritus on the windowsill, a multitude of jumpy, crawly things, sensing fresh blood, hurling themselves against the glass.

I take a step back, scratch my head, then try his mobile once again. I can hear it ringing somewhere amongst the trash, but it doesn’t rouse him anymore than my banging on the window.

Even though it looks from here as if he just doesn’t want to acknowledge my presence, I can’t rule out the possibility that he’s unwell with a hypo or something. But just as I try the handle of the door to see if it’s actually open, a woman coughs and says hello from the end of the path.

‘Have you come to see Jeremy?’

‘Yeah. I can see him sitting in his chair but he doesn’t seem to want to come to the door.’

‘I’m Sharon, his neighbour,’ she says, holding out her hand. ‘It’s probably down to me that you’ve been called.’

‘Oh?’

We chat in the cover of an overgrown buddleia.

‘We’ve been increasingly worried about Jezza,’ says Sharon. ‘He’s been on the slide for some time now, a good few years. Ever since Eric died. Then he lost his job, and things went from bad to worse. He hasn’t put a foot outside the house in eight months or more. If it wasn’t for us and number twenty, he’d have starved to death. He’s skin and bone as it is. And his house. Well, I mean, my god…’

‘I know. I can see through the window.’

‘It’s worse inside.’

‘I’ve got shoe covers.’

‘Yeah? I think you’re gonna need something more than shoe covers. You need one of them bio hazard suits you see in the films.’

She mimes one, holding her arms out to the side, rocking a little from side to side and puffing out her cheeks.

‘I could totally use it,’ I say. ‘But I’ll just have to make the shoe covers stretch.’

‘Good luck with that.’

‘What does his doctor say?’

‘I mean – they have tried, bless ‘em. But it’s difficult. He was driving to the supermarket till recently.’

She turns to look at the wreck on the road outside the house, a mossy old Rover saloon, melting into its tires. ‘Mind you,’ she says, ‘I’m glad he’s done with all that. He was a menace. He used to go at five miles an hour, all the traffic building up behind him, going crazy. And he wouldn’t park so much as randomly stop and get out. It’s a shame. He used to be a nurse, funnily enough.’

I’m just about to ask Sharon some more questions when the front door opens and Jeremy pokes his head out.

‘Ah! Hello Jeremy!’ I say. ‘Sorry to disturb you.’

‘That’s okay,’ he says in a voice as smooth and dry as grease-proof paper. I can see from here how emaciated he is, the ribs and bumps and hollows of his torso a testament to years of self-neglect. He opens the door wider and smiles unexpectedly, with a flare of yellowing stumps

‘How can I help?’ he says.

a head for depths

Craig has the key so we agree to meet outside Sally’s flat at midday, when he’s due to make her lunch.
‘Have you been here before?’ he says, bending down to stretch some blue plastic covers over his trainers.
‘I hear it’s bad,’ I say, taking some out of my bag.
‘It’s not the worst, but you’ll definitely need these.’
Craig seems tired, a reflection of my own state of mind. It’s not so much the number of patients on the list and the number of miles we cover, hurrying from place to place. It’s more the endless parachuting in to situations that are failing in one way or another, trying to set them straight – or, at least, straight enough so you can feel some kind of progress is being made, and that things might change for the better.
An adult safeguarding report has already been put in on Sally, but it’s complicated. In the meantime, we’re going in to do what we can to ameliorate the situation.
‘Ready?’
‘Ready.’
‘Okay then.’
He knocks on the door and then opens it with the key.
‘Sallly? It’s Craig – and Jim. From the hospital. How are you doing?’

He’s right. Whilst it’s not as bad as many places I’ve been in, it’s definitely the kind of place you have to start with shallow mouth-breathing for a minute or two, till you’ve adjusted sufficiently to breathe normally through your nose. Walking down the hallway, our covered shoes make the ticky-tacky noise so characteristic of encrusted and unsanitary surfaces, and the air has a familiar and gloomy sag to it.
‘Hello?’

Sally’s waiting for us in the lounge, in an armchair so low and squashy and discoloured it looks less like a piece of furniture than some giant, malignant bloom. She’s wearing an electric blue silk nightie with a green cardigan over the top. Her bare legs are mottled, swollen, pressed together at the knee. She smiles easily, reaches up to shake our hands, but her conversation is muddled and difficult to follow. One of my tasks is to take some blood, to determine whether infection is making her more confused, but I can see I’m going to have to sidle up to it.

Whilst Craig busies himself preparing a microwave meal in the kitchen, I chat to Sally about this and that, and take her observations as carelessly as I can, almost as if I’m as surprised as her to be doing it.

When Sally talks it’s the equivalent of pretend writing. The patterns of her words, the fact that they follow a line, and start and stop in the usual way, with the usual loops and flourishes, everything looks superficially like conversation. But the truth is, I have to make assumptions about what she might mean, and reflect it back to her, and she’ll either laugh or frown, or wave her hand in the air, and we’ll move on, as if something’s been said, though neither of us really knows. But there’s the reassurance of the tone of what we’re saying, if nothing else, and it does seem to be working. She’s distracted sufficiently to let me take some blood, and whilst she obviously doesn’t have mental capacity to refuse, I take the fact that she doesn’t pull her arm away as consent.
Just before I actually puncture the vein, I ask her some more about her family, particularly her father, who (I think) she said was a miner.
‘Have you ever been down a mine?’ I say, preparing the needle.
She answers with a laugh and a string of garbled words that, if they were in a foreign language and I was forced to guess the meaning, I would say: That was a long time ago now / He was a lovely man / He worked so hard.
‘He sounds great!’ I tell her. ‘You know – I’ve always quite fancied the idea of going down a mine.’
She laughs again.
The blood flows into the tube.
‘God knows, it must be a difficult job.  But I quite fancy seeing what it’s like. I mean, when you think where it all came from, what it was, all that coal. Millions of years ago, all these giant trees and plants in some wacking great swamp somewhere, and then it all gets buried and changed into black rocks you can burn. I know I probably wouldn’t pay much attention to any of that if I had to go down in a cage every morning and swing away with a pick. If that’s what they do. I’ve really no idea.’
She listens to me with a tolerant smile on her face, tutting at some things, frowning at others, but keeping her arm still so I can get what I need.
‘There! All done!’ I say, taping a piece of gauze to the crook of her arm. ‘You’re a model patient!’
Meanwhile, Craig has come through with lunch. He’s standing just behind me with a tray of Lancashire hotpot.
‘You thinking of a career change, Jim?’ he says, helping Sally get set up in the chair, ready.
‘Me? Maybe,’ I say, stashing the phials of blood and peeling off the gloves. ‘I don’t know though. I’m not sure I’ve got a head for depths.’

happy days

Ralph reminds me of that woman in Happy Days – not the Fonzie sitcom, the Beckett two-hander. She’s buried up to her waist in a mound of crap, but seems oblivious, wittering on to a taciturn husband who sits at the bottom of the heap passing her stuff every now and again. Ralph isn’t quite buried, but it wouldn’t take much. A sneeze would do it. He’s lying precariously on his side on the very edge of a large double bed that’s piled high with rubbish. And it’s not just the bed. The whole flat is submerged, with only a trackway through the rubbish to get you from the front door to the bedroom and – at a push – to the bathroom. At least the budgie in the front room has a cage to protect its space from the rising tide of crap, although quite how Ralph ever manages to make it over there to feed and clean it is a mystery. The bird sits on its perch flicking its head in spasms of attention as I pick my way through to Ralph, who calls to me from the bedroom.
‘The bag needs changing,’ he says.
He’s right. His catheter bag is as tight as an overfilled water bottle, straining at the seams, filled with a sloughy, orange-tinged mess.
It’s hard to know where to begin. There’s nothing in the flat to clean him up, scarcely room to put my bag down let alone install equipment. We often talk about setting up a micro-environment for anyone with significantly reduced mobility. That means having all the essentials to hand – a commode, urinal, frame to help with transfers, maybe an over-bed table for food and water, a phone nearby and so on. I can’t help noticing that Ralph has already set up his own version of the micro-environment: a pile of porno mags, a remote control and a combat knife.
I’m half-way through sorting out his catheter when I hear a knock on the front door.
‘Who’s that?’ I say. He shrugs.
When no-one comes through, I go to check.
The front door is slightly ajar. Just in front of it on the floor, about an arm’s length from the threshold, a big bag of bird seed.