Billy’s nest

I’m waiting for Georgiou, the physiotherapist. It’s a smart street, not at all the place you’d expect to find a hostel like this – not because the effects of alcohol and drugs aren’t universal, but because the rents are so high. Maybe it was some kind of bequest. Fact is, the Georgian terrace houses either side and across the road are as fancy as you’d expect for a street off the main drag of a wealthy seaside resort.

A Mercedes Uber pulls up. A man and a woman dressed immaculately in 1920s costumes hurry out of a door opposite and jump laughing into the back of it. If it wasn’t for the modern car with the decal on the side, I’d be worried I was seeing ghosts. I watch the car pull away, and see Georgiou standing on the other side waiting to cross.
‘Did you see that couple?’ I ask him.
‘What couple?’ he says.

I buzz the intercom and the door clicks open. Inside there’s a tiny, security lobby with nothing in it but another door and a perspex grille to the side. A woman frowns at us through the grille. I hold my pass up, she scrutinises it, then clicks us through the inner door. We walk round to the front of the office, which is a counter with another screen. She’s waiting for us with a ledger and a pen. It’s a confusing interaction; she uses code words and acronyms I’ve never heard before, and gets huffy when I ask what it all means.
‘Just sign here,’ she says, jabbing at the ledger with a biro. ‘And take this…’
She hands me a radio and a bunch of keys.
‘Press to talk,’ she says, holding her own radio up.
‘Yep. Got it!’ I say, waving the radio.
‘No. Press to talk,’ she says, then presses the side button on her radio. ‘Testing, testing…Control to R2, receiving…?’
‘Oh! Right!’ I say. Then I press my button and talk back.
‘R2 receiving, loud and clear. Erm…. Over.’
‘You don’t have to say all that,’ she says, clipping her radio back on her belt. ‘Just talk’

Once I’ve filled out the ledger with our details, the woman tells us that Billy, our patient, lives right at the top of the hostel.
‘It’s a long way up,’ she says. ‘Keep going till you can’t go anymore.’
‘Do we need oxygen?’
‘No. It’s not that high.’
I’m aware of her watching us as we go through the first fire door and start walking up.

‘Billy has breathing problems, discharged after a recent exacerbation, lives at the top!’ says Georgiou, striding ahead of me. ‘Makes perfect sense.’
The stairs go on forever, getting narrower and steeper as we go, first floor, second floor, third, up and up and up, past landings of decreasing size, everything warping and tilting like the house is morphing into a giant tree.
‘Where does this guy live – a nest?’ says Georgiou.
And finally we’re there, standing outside Billy’s room, panting. I lean on the balustrade, which wobbles so alarmingly I immediately stand up straight again.
Georgiou knocks.
‘Hello Billy?’ he says, putting his face close to the door. ‘It’s Georgiou, the physio from the community health team, come to see how you are. With Jim, the nursing assistant. Are you up yet?’
There’s a scuffling noise inside. I’m half expecting a giant squirrel to open the door, and actually I’m not far wrong. Billy is a hunched middle-aged guy, his t-shirt riding up over his belly, huge, dilapidated fur slippers on his feet, a tin of Golden Virginia clutched in his paws in lieu of an acorn. If he ever had a tail, he’d long since taken it off and wrapped it around his head for a beard instead. It seems to twitch as he stares at us.
‘What?’ he says.
‘We’ve come for a physio assessment,’ says Georgiou.
‘What kind of assessment?’
‘We want to see how you are on the stairs.’
‘Me?’ he says. ‘Terrible! There! That was easy! I’ve got the cee oh pee dee whatsit, I’m getting over a chest infection, I drink a bottle of rum a day, so all in all you might say I’m running out of options.’
‘I’m sorry to hear it.’
‘I’m sorry to say it. But what can you do?’
‘I think the first thing would be to get you in a flat nearer the ground.’
‘That’s true. You’re right there. They’re working on that … so they tell me.’
The radio squawks in my hand so violently I almost drop it.
Control to R2! Control to R2! Status update. Over.
I press the button.
‘Yeah. All good, thanks’ I say. Then, as an afterthought: ‘Over’.
Control out.
Billy laughs.
‘You know the best thing about radios, doncha?’
‘What’s that?’
‘The off button. So c’mon then. A stair assessment. Okay. Ready? There’s a fackin’ lot of ‘em. There! Bosh. Done. Thank you very much and goodnight.’

The nightlife of Berlin

‘How are you getting on, Jorge?’
‘Fine. I’m just finding somewhere to park. I won’t be a minute.’
‘See you in a bit, then.’
I put the phone back in my pocket.
Take a breath.
Lean against the railings.
Look around.
I can’t see Jorge’s car, though, which is odd. There’s a clear view up and down the road, and of the D-shaped green just opposite.
I wonder if I’ve got the right address.
I have a sudden feeling of dislocation. Everything seems unnaturally still, like I’ve wandered into an old plate photograph in the short walk from my car to these railings. But instead of a frozen horse and cart, a geezer in a bowler hat, a woman in a hooped skirt and bonnet, there’s a guy in a T-shirt sitting in his van staring at the front door where he dropped his tray of groceries, and across the road, a man in white surgical gloves staring at a rack of rentable bikes.
I wait.
Re-shoulder my bag.
Look around some more.
I can’t see Jorge’s car anywhere. Maybe I have got the wrong address.
I ring him again.
‘Yes, yes. I’m just coming. Look! I can see you…’
But I can’t see him!
It’s peculiar – then, suddenly, bursting through the paper of the photograph, there he is, waving his phone in the air from the centre of the grassy D, and everything comes back to life. The delivery driver slams his door and moves off. The guy begins wiping down the saddles of the bikes.
‘Have you been here long?’ says Jorge.
‘Hardly any time.’
‘Come on. Let’s see if he’s in this time.’

We’ve teamed up for the assessment because there’s a safety caution both for Gary and the address. Gary had suffered an injury to his leg and gone to A and E, but it was obvious from all the collateral noise around the referral – emails between the hospital, surgery and social services – that no-one knew what to do with him or felt able to take responsibility. Gary had such a long history of non-attendance, non-compliance, non-cooperation, non-everything, you’d think it would be easy just to type NON in big red caps on his notes and leave it at that. Except Gary wasn’t quite so definitively NON that he wouldn’t stop presenting at the hospital complaining he couldn’t cope. As a last resort he’d been referred to us. We’d tried over the last few days to get in touch with him, but he didn’t answer the phone, didn’t reply to messages. Then his phone was switched off. None of his other contact numbers worked, or the people who did answer either knew where he was and didn’t want to say, or didn’t know, or didn’t care, or all of the above. A couple of days ago a therapist had let themselves into his flat with the keysafe, but there was no-one in. The next day there was no key in the keysafe.
Today’s visit from Jorge and me is the last throw of the dice.
I ring the intercom.
And again.
And we’re just about to turn round and leave when it crackles into life.
Come up he says. Make sure you put your masks on.

Gary looks a bit like Eddie Vedder from Pearl Jam – or would do, if Eddie Vedder had spent the last thirty years shooting up, smoking crack and eating chips. He stands unsteadily at the flat door, an unlit joint clamped in the corner of his mouth, his puffy eyes squeezed shut like a sick and denuded mole coming up for air. He’s naked, except for a threadbare dressing gown and a velcro support boot.
He waves his hand in the air.
‘Come on in,’ he says.
We rustle after him, stand hopelessly in the middle of the room as Gary waddles to the sofa and eases himself down into it.

These days we have to gown and mask up for every patient – to protect them as much as us. And normally I hate it. Not only is it uncomfortably hot, but it also acts as a barrier to that open, human interaction you depend on so much to get things done, move things on. Now I’m glad of it. The room is as fetid and unkempt as Gary, ropes of old spider web hanging down so thickly you could jump up and swing from one side of the room to the other. There’s a case of beer on the kitchen counter, scatterings of pill packets, smoking gear, not much else. The TV looks like it’s been punched off.
‘Hello Gary,’ says Jorge. ‘You know – everybody’s been trying to get hold of you.’
‘Before you start,’ says Gary, shakily hooking his lank hair to one side. ‘Before you have a go, I’ve just got to do this. Alright? I’m breathless. I need to do my puffer. Okay? Is that okay?’
‘That’s fine,’ says Jorge. ‘You need to take your medication. We can wait a minute.’
‘Thank you,’ he says.

There’s a glass coffee table in front of him. On it is a spacer device with an aerosol of beclomethasone in one end, a glass of water, a mug of tea and a DVD of a guide to the nightlife of Berlin. Gary picks up the spacer device, gives it a shake, squirts the aerosol, puts the business end of the device in his mouth, and starts breathing through it, slowly and deeply, for five goes. Then he lowers the device. Gives it another shake. Another squirt. Puts it to his lips, repeats. When that’s all done, he gently and reverently puts the device back on the table.
‘Good. Well done,’ says Jorge.
Gary holds a finger up.
‘Just a minute,’ he croaks.
He picks up the water, takes a mouthful, puts the glass back down, leans back on the sofa, tips his head, and begins to gargle – a long, deep sound, like a lumpy old British motorbike. It seems to go on forever. Me and Jorge exchange looks over the line of our surgical masks. Gary takes another sip of water. Repeats the gargle. Swallows loudly.
‘Better?’ says Jorge.
‘Just a minute. Please. Just a minute,’ says Gary.
He takes the tea – very slowly – and takes a sip of that. Then he takes the DVD of Berlin and places it on top, to keep the tea warm.

A man appears from a room just behind us. He’s as grey and ruined-looking as Gary, except longer in the body, more stooped.
‘I’ll keep outta your way,’ he says, and ducks back inside.

‘So – Gary!’ says Jorge, clapping his blue gloved hands together. ‘You’re a difficult man to get hold of. Why didn’t you answer your phone when we’ve been calling?’
‘I was in too much pain.’
‘Yes – but – you see, if you don’t answer your phone, we start to get worried. One day you weren’t even in the flat.’
‘I’d gone out.’
‘Of course. But then the next day there was no key in the safe.’
‘I told you. I was in too much pain.’
‘But when we can’t see you we start to worry. And then we think about calling the police.’
Gary opens his eyes and looks straight at us – but then lets it pass with a shrug.

Jorge starts trying to explain to Gary who we are and what we do as a service, but Gary already has firm ideas. He doesn’t want physio or nursing – he knows his own body. All he wants is a carer to come in every day to wash his good foot, and maybe give his foreskin a freshen-up with a personal wipe.
‘Excuse me? Your what?’
‘My foreskin!’ says Gary. ‘You know… down there.’
‘Well! I think you can do that for yourself, can’t you?’ says Jorge. ‘I mean – for goodness sake! You need to be as independent as possible.’
‘Where’m I gonna get the wipes?’
‘From the shops. Any of the supermarkets round here will sell them.’
‘They haven’t got any.’
‘How do you know?’
‘Because Stu does my shopping.’
‘Is that Stu in there?’
‘Yes. But he’s not there all the time.’
‘But he is there some of the time.’
‘So maybe Stu could buy enough for the week when he goes.’
‘I just told you. They haven’t got any.’
‘It’s not the sort of thing we do, I’m afraid, Gary. We’re an emergency service. We have to look after very sick and vulnerable people. People who don’t have other people around them to help. You’ve got Stu. So that’s good.’
‘What you’re saying is, basically, you can’t do nothing for me?’
‘On the physio side, maybe. Do you have a support worker?’
Gary shakes his head.
‘That’s gone, now,’ he says. ‘That’s all finished.’
‘I’m sorry to hear that.’
Gary bristles.
‘If you’re not going to help me with the things I need, then what use are you? Just get out.’
‘Okay. That’s fine, Gary. We will go. And we’ll refer you back to your GP.’

Back outside, the air is wonderfully cool and fresh.
‘What a complete waste of time,’ says Jorge. ‘I think he was playing some kind of stupid game with us. What do you think?’
‘He was using that spacer device like a crack pipe.’
‘Yes! And my God – when he started gargling like that! I didn’t know where to look!’

A young couple pass by on the pavement, both of them hugging cardboard boxes of supplies. There’s such a tangible air of competence and vitality and neighbourliness about them I can’t help smiling.
‘Where did you park?’ I ask Jorge.
‘Over there! Under that tree!’
‘Let’s walk together!’
So we do.