tangled up in brown

I let myself in with the key from the keysafe.
‘Hello? Jack? It’s Jim, from the hospital…’
The bungalow is profoundly quiet, a heaviness to the air, cloying top notes of sweat and something else, the noxious atmosphere accentuated by the solitary drilling of a fly. Curtains drawn, a soupy brown half-light through drawn curtains. A door at the far end of the hallway standing open.
‘Hello…?’
Into the bedroom. The single bed on my immediate left rumpled up, nothing on it but a soiled bottom sheet, rucked up with a bias to the left; the contents of the side cupboard spilled or spilling; a chaotic pattern of smeared brown stains on the white wardrobe doors and across the floor – and then Jack, naked, lying on his back on the floor beside the bed, a lit desk lamp clutched to his chest, the cord tangled around his arms and legs. At first I think he’s dead, but then I notice a trembling in his abdomen, intermittent breaths, and when I touch him on the shoulder nearest to me, he shudders, opens his eyes and stares straight up at the ceiling, smiling in a beatific way, as if the touch was the answer to a long vigil of prayer.

I call for an ambulance once I know he’s breathing and stable. Even though they say they’ll do their best to get here quickly, and despite his poor condition and the likelihood of a long lie, he’s still only a medium priority and there’s a chance the ambulance may get diverted to something else. In the meantime I set about trying to assess Jack more thoroughly, and make him more comfortable. I put blue overshoes on, a plastic apron, gloves, and set to work. I turn off the lamp and gently disentangle him from the lead. After a quick top-to-toe that seems to exclude any obvious fractures, I use whatever pillows and bedding I can find to put under and around him to ease his position. I run a quick set of obs. I’m just about to go into the kitchen to find a beaker for water when Jack’s son Joe arrives. Joe is shocked by his father’s condition, but he manages to contain it for the future in the cause of setting things right in the present.
‘He was fine when I put him to bed at half seven last night,’ he says, putting on the overshoes and gloves that I give him, then helping me shift the furniture around to make room for the ambulance crew. ‘He’s had this UTI recently. The antibiotics haven’t been touching it. He was hallucinating about cats last night. He said the house was full of ‘em. I was going to talk to the doctor today to see what the plan was.’
He looks down at his father, and shakes his head.
‘Why didn’t you press your button, dad?’
Jack opens his eyes again and makes some incomprehensible sound.
‘He’s pretty dehydrated. I was going to give him some water,’ I say. ‘It’ll have to be in a beaker, though. His blood pressure’s quite low and I’m wary of sitting him up too much.’
‘I’ll see if he’s got one somewhere,’ says Joe, and pads off into the kitchen to find one.
Meanwhile I fill a basin with soapy water, get some dry wipes out of my bag and start cleaning Jack up. He’s in a terrible state. I’m guessing he must have had several episodes of diarrhoea through the night, the smear marks on the floor and wardrobe where he scrabbled around ineffectively. His hands are caked, his long nails thickly rimed, his body filthy – even the lamp is covered in smeary hand prints where he’s hugged it over night – for warmth, or light, it’s impossible to say.
I start work on his face and hands.
The ambulance arrives.
A paramedic walks into the room, clutching a clipboard.
‘Oh my good God!’ he says. And then, looking at my apron and overshoes, adds: ‘I don’t suppose you’ve got any more of those, have you…?’

watertight

Glenda’s smile is so utilitarian I imagine she keeps it on a hook by the door.
‘Thank you so much for coming,’ she says – then waits in the hall for me to enter.
‘Shall I take my shoes off?’
‘Not many of your colleagues do.’
‘It’s what I do at home,’ I say. ‘It feels weird otherwise’
She watches as I slip them off and line them up with the others.
‘Easy on, easy off!’ I say, although the faux-Cockney falls flat.
Glenda watches me, one hand hooked over the other, a self-conscious and mechanical kind of coupling, like a robot that hasn’t had the soft skills upgrade.
‘What people don’t realise is the toxins they’re tracking through the house if they don’t take them off,’ she says.
‘No. Exactly. And anyway – I like the feel of a wooden floor under my socks. So…’
I wait for her to lead me through to her mother, the patient I’ve come to see, but Glenda stands absolutely still.
‘Take tarmac, for instance. They seal it with a cocktail of chemicals that are severely detrimental to one’s health. The sun comes out, the sealant becomes tacky, it adheres to the underside of the shoe, and you walk it in. Tests have shown the average household dust carries concentrations of harmful toxins such as PAH, which is implicated in respiratory and other illnesses.’
‘I bet.’
‘And then there are the bacteria, of course. E coli. C. diff. Klebsiella’
‘Yes.’
‘Not to mention all the debris and dirt you’d expect to find in the street and the garden.’
‘So – are you a microbiologist or something?’
She flinches.
‘No! I’m a lawyer’
‘Oh.’
I shoulder my bag in a resolute way that’s supposed to indicate I’m ready to move on.
‘You do understand the situation here,’ she says, after a significant pause.
‘Well – I think I do. The basics.’
‘Perhaps I’d better explain,’ she says. I adjust the weight of the bag on my shoulder.
‘My mother is ninety years old, a fully independent person who lives without assistance in a small village in Somerset called Duckton. She was on a visit to us when she became ill with a urinary tract infection, and suffered a minor injury fall, and was taken to hospital, where she spent three days. The hospital deemed her to be medically ready for discharge, on the understanding was that she should have one month of community rehabilitation, with therapy and nursing support, and care three times a day. Which is where you come in.’
‘Okay.’
‘There have been a number of medication changes effected at the hospital, and these have all been ratified by my own GP, who has taken temporary care of my mother whilst she is away from home.’
‘Great.’
‘Now. What I need from you – other than a medical review this morning – is to provide a report detailing all therapeutic programmes undertaken by your department, nursing interventions and so on, and for these to be communicated to my mother’s health authority in Somerset. I want assurances that all possible measures will be taken to maintain her safety when she returns home, provision of all necessary equipments and so on, and continuing care support from agencies in that county. Is that something you can help us with?’
Glenda talks in such a relentlessly steady way that it’s something of a lurch when she stops, like coming down a long flight of stairs and unexpectedly putting your foot down flat.
‘Well…erm… that’s not usually how it works.’
‘Explain to me how it usually works.’
I blush, and cast around for a friendly face. All I can find is a vast, frowning, butterscotch cat staring at me from the cushion of a Windsor chair. It looks so severe I wouldn’t be surprised to see it reach up and place a square of black cotton between its ears.
‘The thing is – Glenda,‘ I say, swallowing drily. ‘We’re an acute team. We get referrals from the doctor, the ambulance or the hospital, and we go in, and we make sure everything’s okay. Nursing, therapy, care or what have you. And when we’re done we refer back to the GP. Or make other referrals for chronic, longer-term needs, to the district nurses and others. And that’s about it.’
She sighs, once, heavily, as if she’d asked for architectural plans and been given sugar paper with a crayon sketch of a house.
‘It’s a question of resources,’ I say, helplessly. ‘A real world thing. We struggle to look after the people who live here, let alone the other side of the country.’
‘As I explained to you,’ she says at last. ‘I’m a lawyer. Now. A piece of paper with a signature on it constitutes a contract. And your service has contracted to provide us with one month of therapeutic, nursing and auxiliary care needs, prior to repatriation.’
‘Has it?’
‘Are you telling me this is not actually the case?’
I pick my bag up.
‘Glenda,’ I say.
She gives a small nod of her head, activating another, thinner smile.
‘I’ve come here this morning to see your mother. To see how she is, do her blood pressure and so on. I have an awful lot of other patients to see today, so I haven’t really got time to talk about the finer points of these things, much as I’d like to. So do you mind if we…?’
The smile flicks off again.
‘For example. If I was buying a boat,’ she says.
‘A boat?’
‘Yes. A boat. There are certain rules pertaining to the transaction that would need to be adhered to in order for that transaction to be properly concluded, to be watertight.’
An anguished voice calls out from the front room.
‘Who’s that at the door, Glenda? Is it the nurse?’
‘Coming!’ I say, shrugging, and holding up my hands. ‘Just losing the shoes…’

playing it safe

Aaron doesn’t believe me when I tell him he spent the night in hospital.
‘I’m not crazy,’ he says, folding his arms. A massive figure in khaki shirt and trousers, he occupies the entire sofa. Despite his size, his monkey boots seem disproportionately enormous – although they’re nearer to me, so it’s probably just a matter of perspective.
‘Where do you think you were, then?’ I ask him.
‘A holiday camp,’ he says. ‘I remember it distinctly. Everyone had their own chalet – except, we had to share the toilet, for some reason.’
His friend Marcus shifts uneasily on his chair.
‘Don’t worry,’ I say, trying to reassure them both. ‘This sort of thing’s quite common with urinary tract infections.’
‘What – thinking a hospital’s a holiday camp?’
‘Getting confused about things, yes. Hallucinating, sometimes.’
‘But I can see it all so clearly. Everyone was deliriously happy. They were walking around in couples. And there were these beautiful people in shining white uniforms giving everyone delicious things to eat, beautiful things, off trays.’
‘Doesn’t sound like any hospital I know,’ says Marcus.
‘I’m not crazy,’ says Aaron.
‘No-one thinks you’re crazy,’ I tell him. ‘We just think you’ve got a bit of an infection and you’re not quite yourself.’
Aaron rubs his face a couple of times, making it seem even redder than it was.
‘It was just the toilet arrangements that struck me as odd,’ he said. ‘I certainly didn’t think I was in any kind of hospital.’
He takes a deep, sighing breath, then restlessly scratches his head – something he’s been doing off and on the whole time. His hair is matted and wild, like he worked in a fistful of gel and then hung upside down from a tree. I’m worried he might have a fever, but the temperature comes back normal.
‘So – what happened to me exactly?’ he says.
‘You went round to see some friends…’
‘…I wasn’t there,’ says Marcus, carefully, like if he had been, none of this would’ve happened.
‘How did I get there?’
‘You drove. Apparently.’
‘I drove?’
‘Someone standing outside A and E saw you pull up, open the door, and fall out.’
‘Did I?’
‘The car’s still there.’
‘I’m picking it up this afternoon,’ says Marcus. ‘Don’t worry.’
‘I’m not worried about the bloody car,’ says Aaron. ‘I’m worried about my sanity’
‘Like I say – you’ve got a UTI. They can seriously throw you off your stride.’
‘So then what happened?’
‘So then this person got a wheelchair and took you inside. The doctors treated you. And you were sent home. They asked us to come in and keep an eye on things, to make sure the antibiotics kick in, but other than that, you should be okay.’
‘I’m staying tonight,’ says Marcus. ‘So that’s good.’
‘I don’t know,’ says Aaron, taking one more colossal breath, and then blowing it out again almost immediately, like a whale before it dives, nose down into those uncertain depths of ocean the sun struggles to reach.

-oOo-

I’m just back at the car getting ready for the next appointment when I get a phone call from Marcus. He has a few meandering questions about the treatment and so on, but I can tell he’s stringing it out, and there’s something else bothering him. Eventually he gets round to it.
‘You’re a man of the world,’ he says.
‘Oh? Okay! Maybe. How can I help?’
‘This thing is – this thing – Aaron has. This infection. If I lie with him tonight – can I catch it?’
‘Well – a UTI isn’t a sexually transmitted disease, so it doesn’t work in the same way. A condom’s not a bad idea, though, just to play it safe. You don’t want to get a UTI of your own. Bacteria that live in the bowel are one of the main culprits.’
‘Okay. Thanks. I’m just off to get his car back.’
‘That’s good of you.’
‘I know. So. D’you think it’ll be clamped?’
‘The car? I hope not. You know what those parking people are like.’
‘Yeah. Anyway. Who knows? Maybe I’ll be lucky. Maybe they’ll just put a massive condom on it. To play it safe.’