the plan

Stress is like bad weather. You could draw isobars on a map. Arrows indicating direction of flow. Cloud banks. Lightning.

The Out of Hours team had taken a stormy call from Graham first thing that morning. He said his mum Sara had effectively been fly-tipped back home, and the promised follow-up from our community health team scheduled for the next day was completely unacceptable.

I didn’t know anything about it, so before I picked up the phone to call Graham back I scrolled through the extensive notes on the system. They described how Sara had been admitted to hospital by ambulance with an infection, then subsequently found to have suffered an ischemic stroke. Unfortunately she still had marked problems with balance and coordination even after thrombolysis, and her speech, memory and mood were also affected. Various treatments and therapies had been started, but Sara had become distressed and unhappy on the ward. Graham attended a multi-disciplinary meeting to weigh-up the benefits of keeping Sara in hospital with the risks of sending her home. Everyone had been in agreement: the plan was to discharge on the understanding it would be bed care only for 48 hours until the community health team could assess and organise the necessary moving and handling equipment. Carers had been arranged to come in four times a day to help with all of this.

A substantial set of notes, but one that demonstrated the lengths the hospital was prepared to go to get Sara back home as safely as possible.

When finally I manage to speak to him, Graham is as cross as the Out of Hours operator had described.

‘I’m not stupid’ he snaps. ‘I know what they’re really worried about. They just want the bed. They couldn’t care less. But what they don’t seem to understand is how much my mum used to do for herself. She was an independent lady. She couldn’t bear to lie around all day. I can’t just leave her there, soiling herself in those pads. I mean – there’s nothing here for her. If I can help her to the commode I will…’

He races on barely pausing to breathe, mixing in the horrors of his mum’s current situation with anecdotes about the bridge club she went to twice a week, the dog, the twins’ birthday coming up, the state of the garden and so on. If I didn’t have the MDT summary in front of me I would never have guessed that Graham had been there at all.

As gently as I can I try to go over the plan as described in the notes. Bed care only, until the community health team can go in the next day to assess all transfers and order up the necessary equipment.
‘It’ll go in as urgent,’ I tell him. ‘We’ll work as quickly as we can.’
‘She’s an active person!’ says Graham.
‘Yes, but then – of course – she’s had this stroke…’
‘All this lying around isn’t good for anybody. She’ll get bed sores. She’ll go mad.’
‘I think the plan is to go steady and build your mum’s strength up gradually. The last thing you want is for her to fall, break something, and go straight back to hospital. It didn’t sound as if she was very happy there.’
‘She wasn’t happy.’
‘No. So look. We’ve got to take things steady and give them time to work. The carers will be coming in through the day and evening. We can organise someone in the middle of the night if that would help, too. We’ll get a therapist in to assess all the manual handling angles, see about a hospital bed and take it from there. How does that sound?’
‘I think if my mum wants to get out of bed I’m not going to sit there and do nothing. I know you don’t like it, but there you are. I’m just being honest. I know what I can and can’t do. And what I can’t do is simply sit there and put my fingers in my ears when she cries out.’

As sympathetically but as clearly as I can I go over the plan again. Graham is too stressed to take it in, though. After I put the phone down I talk it over with my colleagues. We look at the schedule but there’s nothing we can do to bring the manual handling assessment forward. The best we can do is send a nurse in to do a quick review of obs, pressure areas and a welfare check.

I give the nurse a heads-up on the situation; she thanks me with an ironic smile.
‘Why d’you always give me the difficult ones?’ she says.


When I see the nurse at the end of the shift I ask her how the review went.
‘Easy,’ she says.
‘Oh? Really? Wow! I’m amazed. Graham was so incredibly stressed on the phone.’
‘Well I wouldn’t know about that,’ says the nurse. ‘There was no-one in. Turns out his mum fell. She’s back in the hospital.’


I’m running late. Jess is opening a charity gig, onstage six thirty. It’ll take forty five minutes to make it there this time of day. I’d been doing so well, too. This decision, that treatment, this referral, that email, this cup of coffee…. frenetically pitchforking my way through the day’s workload like a demented farmer at harvest time. And I thought it was all behind me, and I was good to go. Except the lead nurse caught me and said the district nurses had missed a visit and could I go with David as back-up, because it was in a hostel and that was the policy.
‘It’s just round the corner. Then you can go home from there. You’ll be fine.’
I grabbed my bag and left, calling David on the phone as I went. We agreed to meet outside the hostel. A quick visit. Pretty much a drive-by. I should be out of there in ten.

There is a guy in a dark blue tracksuit and trainers sitting on the steps of the hostel, sipping from a can of lager, watching the cars as they pass along the main drag.
‘Champion,’ he says, raising the can. He has buzz-cut hair that highlights the riot of nicks and bumps that cover his scalp. When he smiles, his teeth are gappy and black.
‘I’m waiting for the other nurse’ I tell him, looking up and down the street. ‘He should be here any minute.’
‘Got ya.’
I lean against the railings and try to look relaxed, even though I’m so hyper I wouldn’t be surprised to see the entire building immediately light up behind me and start to tremble.
‘So how are you?’ I ask the guy.
‘S’all good, mate. All good. I’m moving in to a proper place next week.’
‘Yeah. I was six months sleeping down on the front in a tent.’
‘That’s tough.’
‘I dunno. Some things were. But then y’know what? I’d step out first thing in the morning and there was the sea and the sun, right there, like, and I’d think – shit, man – you’d pay a million quid for a view like this.’
‘Did you ever get any hassle?’
‘Nah. Not much. There were a few of us down there and we looked out for each other. It weren’t too bad.’
‘That’s good then. Still – great to get a place of your own. Especially with winter coming on.’
‘I’m in a bit of a rush tonight.’
‘Why’s that?’
‘My youngest daughter’s playing a gig tonight. It’s like this battle of the bands thing, and she’s opening. Doing a couple of numbers on her loop pedal. And I absolutely can’t miss it.’
‘Well it’s your daughter, man. You can’t miss a thing like that.’
‘I don’t want to’
‘No way.’
‘I’m a musician too, y’know?’
‘What d’you play?’
‘Guitar. And I sing, too. Write me own stuff. We’re organising a gig down on the front in a few months. There’s a guy I know might do us a deal.’
‘That’s great. I’ll look out for it.’
‘Please do.’
He takes another swig from the can and studies me with an appraising, sideways squint.
‘Don’t take this the wrong way, fella, but – y’know what? – if it weren’t for the uniform – you look rough enough to fit right in here.’
David comes striding round the corner.
‘Sorry I’m late’ he says. ‘Let’s do this.’
The guy on the steps stands up and to the side.
‘Tell your daughter good luck from me,’ he says, offering me his hand after wiping it twice on his tracksuit top.
‘Thanks. I will.’
And we hurry inside.