ETOH

It’s quite a contrast to see the two of them together – Alex, wraith-like, matted hair, scooped eyes, shivering, hugging his legs in bed with a filthy duvet piled up around him; and Graham, the support worker from the alcohol and substance abuse team, shaven-headed, gym-fit, in a smart grey reefer jacket and leather man bag, perched on the arm of the sofa with his hands in his pockets. It could be a fashion shoot for an edgy magazine.
‘You’ve got this far, yeah?’ says Graham. ‘Hats off to you, mate. It’s no easy thing you’ve done there. Don’t go and spoil it now. After all we’ve been through. You got to realise – this is a disease we’re talking about, yeah? There are all kindsa toxins and shit floatin’ around your body right now. You can’t just expect to jump up and be cured. It’s a long, hard process. And you’re doin’ great, man! Isn’t he? This guy’ll tell ya…’
‘You are. Graham’s right. Alcohol addiction’s the hardest thing.’
‘See what I mean?’
Alex doesn’t seem convinced. He draws his legs closer to him, gives his head a peremptory shake.
‘I don’ know, man. I jus’ feel like I’m wastin’ everyone’s time. I mean – I brought it on myself.’
‘You can’t afford to think like that,’ says Graham. ‘Everyone’s different. You’re totally worth it, man.’
‘Is there a social worker involved?’ I ask Graham, flipping through his folder.
‘No,’ he says. ‘When they see they’re still drinking they pull out.’
He shrugs, scuffs his shoes in the trash.
‘It’s hard, but it’s just the way it is.’
‘It’s not like I’m not trying,’ says Alex.
‘Yeah – but there’s trying, and there’s doing, Alex. You’ve got to be in a position to accept the help. It’s just how it works. You know that.’
‘Yeah.’
‘We’re here for you, though.’

There are several bottles within easy reach of Alex’s bed – a two litre bottle of cider, a couple of quarter bottles of vodka, some other, less obvious stuff in bottles with the labels torn off. A dull yellow light filters through the filthy windows. The flat is an apocalyptic mess; it looks like an extemporary shelter somebody hollowed out with their hands in a landfill site. Here and there you can just make out traces of the orderly life Alex once used to live. There’s a mountain bike in the hallway, quietly fossilising under a press of junk; over by the window-ledge, a tool box, some work boots.
‘We’ve got to find a way to keep you out of trouble long enough to detox properly,’ says Graham. ‘Yeah?’
‘Yeah,’ says Alex. He doesn’t sound convinced.
Graham shrugs, pushes his hands deeper into his jacket.
‘How long’ve we known each now?’ he says. ‘Gotta be nine, ten years.’
‘Is it?’ says Alex, rubbing his face. ‘Fuck, man! Nine years? No! That’s like…’ He screws up his face to figure out what percentage of his life that represents: ‘…that’s like… a fuck of a long time, man!’
‘I think so,’ says Graham. ‘First time I met you you’d just been beaten up and taken to hospital. You were in a bad way, my friend.’
‘Was I?’ says Alex. ‘I don’t remember.’
‘Yeah – well – you don’t remember much, to be fair. You didn’t remember I was here yesterday, so maybe that’s not headline news.’
‘No. You’re right. Probably not.’
‘I’ve seen you in and out of hospital a hundred times. Lost sight of you for months on end when you took yourself off somewhere. You’d always turn up again, half dead, some new injury. And now look.’
He’s right. I’m reading through the latest discharge summary. For someone so young, Alex has a terrible list of things wrong. In fact, it’s a miracle he’s still here at all. Looking at him on the bed, though, it would be easy to think that maybe he wasn’t – that maybe he’d died that last time in hospital, but his spirit was so cussed it dragged itself back across town to find rest in this cold, cold bed.
‘It’s like training, yeah? You can’t just jump on a treadmill and bang out ten K. You might feel great at the end of it, but the truth is, if you don’t get the intervals right you can be setting yourself up for a lot of trouble. It’s all about the interaction between the sympathetic and the parasympathetic nervous systems, the way your body metabolises the shit and tries to get straight again. Jim’ll tell you. Hey?’
They both look at me – Graham as if he’s about to pick me up and bench press me, Alex with a haunted, shivery look.
‘That’s right,’ I say, ‘Uh-huh.’

the wrecking ball

I knew the street – or thought I did. A utilitarian cut-through in an older part of town, with the sort of uniform civic redevelopment it makes you wonder whether the original buildings fell victim to town planning or the Luftwaffe. The street is dominated on the leading corner by a long, low, smoked glass office building, leading on to other, smaller offices, a single, more original building in a rotten-looking antiques warehouse – mobile phone number painted on the peeling double-doors where the cart used to go in and out – and half way up, a pristine meditation centre, operating out of the old telephone exchange, finding new ways to make connections.

Giles’ block is narrowly squeezed-in, set-back, anonymous, thrown together from the same Lego tin as its neighbours. The only thing that gives it away as a private address is the scrappy intercom console, the names of the people who live there scrawled in marker pen, stuck over with tape or missing completely. Two office workers vape and sip coffee, leaning up against the black pointed railings to the right. They’ve both got such perfect, Edwardian-style beards and moustaches, it’s a shame they can’t get vapes designed like long clay pipes. Before I can suggest it, Giles buzzes me through.

If the exterior of the apartment building looks flimsy and plastic, the conversion inside is even more extemporary. It looks so thin, if I tripped and put out my hand to save myself, no doubt all the walls would tumble down one against the other like a pack of cards, until I was left standing in the shell (with the two bearded vapers peering in at the window).

Giles’ door shows signs of a forced entry. I know he was admitted to hospital after an overdose, so I’m guessing that’s what it was. It wouldn’t have taken much putting-in, that’s for sure. A butterfly could’ve done it. With an ant as a battering ram.

No need for that today, though. Giles is waiting for me in the doorway. He’s gigantic – much too big for this place – a vast, fleshy monolith of a man, wearing an old Motorhead t-shirt and cut-off trackie bottoms. When he turns and leads me into his flat, his left shoulder slightly higher than the right, his palms swipe backwards to help him along, like a polar bear paddling for purchase in the floes. The whole building bounces.

His living room is a mess. There’s one armchair in the middle of it all, blackened and sagging in the middle. When Giles sits himself into it with a thundering sigh, he’s almost completely subsumed, like he’s dropped himself down into the maw of a particularly giant and noxious kind of fungus. He spreads his fingers on the arms – to stop himself disappearing straight through the floor, probably – and regards me with a baleful look.
‘What’s all this about?’ he says.
I explain what the team is and the things we do.
‘I’ve come for the initial assessment,’ I tell him. ‘It’s a formality, really. I think you’ve been referred to us by the hospital for very specific things. For physiotherapy – because I think you injured your shoulder? Is that right? And for some bridging care, to help you get back on your feet. Unless you think there’s any equipment you might need?’
He raises his eyebrows.
‘What do you mean? Equipment?’
‘Well – in the loo, for instance. To help you get on and off. Given your shoulder problems. To make sure you don’t have any more falls.’
‘I fell because of the overdose’ he says.
‘Yeah. But still…’
He gestures behind me.
‘Be my guest. See what you think.’
‘Okay.’

What I think is that the toilet is as terrible as the rest of the flat. I imagine the gateway to Hell might look similar – although I’m sure even Satan would be a bit shamefaced and throw something down there. The only equipment this place needs is a wrecking ball.

‘Hmm,’ I say, going back in to the living room. ‘Maybe I’ll get the OT in to see you after all.’
Giles nods and smiles.
‘I’m sorry,’ he says, making an effort to get up again, but defeated almost immediately. ‘I haven’t offered you tea.’
‘That’s kind,’ I say. ‘But it’s fine. I just had one.’
‘As you wish,’ he says.
We smile at each other.

mandy’s eyrie

Mandy’s flat is at the top of the block – so much so that the lift doesn’t extend there, and we have to walk the last two flights. It makes me think of an osprey’s nest, a junky bundle of sticks wedged in the uppermost branches of a pine. The nest is made up of old music magazines, Janice Joplin posters, empty cans, unpaid bills, unopened nutritional milkshakes, and the osprey itself is a haggard, featherless old bird, smoking a roll-up, staring unblinking over the city.

‘I’m a singer’ Mandy says, her voice so broken she can hardly talk. ‘Or was. ‘scuse the mess.’

She offers us a seat – a dirt-shined cushion in a sixties wicker chair, and a spot at the end of the crapped-up sofa. Standing isn’t an option, but at least this is the last job of the day.
‘Thanks’ I say, and we both – slowly – sit down.

I hardly know where to start. We’d come to see Mandy as a double-up as the notes on her file described how she’d been hearing evil voices telling her to tear herself and other people up.
‘But don’t worry. A and E did a risk assessment,’ said the co-ordinator. ‘No history of violence, and they don’t think this was a psychotic episode, as such.’
‘As such?’
‘No. More to do with alcohol withdrawal. So doubling up should cover it.’

I’ve never really understood the doubling-up rule. The way I see it, it doesn’t matter how many people you send in, someone’s going to get hurt. If anything, having other people with you only acts as a distraction. Although it does make me think of that joke about the two rangers walking in the forest, talking about the danger from grizzly bears. ‘Because they run pretty fast, you know.’ ‘Yeah?’ says the other. ‘Well I don’t have to run faster than a grizzly bear, Chuck. I just have to run faster than you.’
But I suppose it means there’ll be a witness

The other thing frustrating thing about this particular call is that Mandy goes out. A lot, according to reports. She gets drunk, then spends her time wandering the corridors of the block shouting and causing trouble. There’s an on-going spat with an ex-boyfriend who has recently moved in with another woman on fourteenth. And any number of substance abusers scattered through the block mixing things up – socially as well as chemically. All in all it sounds like a recipe for chaos, and not something that’s going to lend itself to regular, well-apportioned community care. At a time of severe underfunding, it seems crazy to throw resources at a patient who has the capacity to decide whether they drink or eat or take drugs or not. It’s a lifestyle choice – however severe that choice works itself out in practice.

But our community health team doesn’t have the latitude or leverage to protest. The referrals come in, we go out.

The brief is to establish regular contact with Mandy. To get carers going in every day to encourage her to eat and get her used to some regularity in her life.
‘It’s only until a more regular provider can pick up’ says the Co-ordinator.

‘I’m sorry I wasn’t in earlier,’ say Mandy. ‘I had to go to the doctor’s.’
‘Oh? How did you get there?’
‘Taxi,’ she says. ‘Well they’re not going to come here, are they?’