Wednesday, April 27, 2016


Mary’s son, Ethan, has come straight out of the shower.
‘She’s upstairs in bed,’ he says, one hand holding the door, the other the towel round his middle. ‘Excuse me whilst I finish off.’

The commotion in the hall has woken Mary.
‘I’m normally a bit more with it,’ she says, struggling to push herself upright. ‘But you see I had a restless night last night and I feel all...’ She smacks her lips drily and waggles her fingers in the air to illustrate.
I explain who I am and what I’ve come to do.
‘Be my guest,’ she says. ‘Only first let me get my plate in. I’ll make more sense.’

I work through the obs. Ethan brings in a tray of tea and then sits down in a low, fabric armchair to drink a cup. He’s the polar-opposite of naked now, wearing a heavy-knit, patterned sweater now, khaki trousers and sandals, all perfectly in keeping with the general, Nordic style of the place: wooden carvings of dragons, masks and heroic figures, prints and sketches, framed academic scrolls. Mary has a bearskin over the bed. 
‘I was younger then, very little observable conscience,’ she says, gently stroking the fur. ‘Poor thing. I feel guilty as hell now, of course, but there you are, the deed was done.’
‘Did you kill the bear yourself?’
‘May as well have.’

When it comes to having blood taken she’s not quite so sanguine.
‘I have a bit of a phobia,’ she says. ‘It doesn’t help that I’m difficult. My veins dive for cover whenever they see a needle. See what you think – but please, not the hands!’
 ‘I can’t believe you’re ninety-five,’ I tell her, tapping around for anything remotely usable.
‘Nor can I. Do you know – I distinctly remember when I was seven years old. I’d come down to visit my grandmother, and she’d taken me for a stroll by the sea. Well, we came across all these ancient folk, on a day out from the local hospital. Being wheeled along the promenade in what amounted to giant baskets on wheels.  You see at that time I was mad about climbing trees. If I saw a tree, I was up it! No better than a squirrel. No bigger than one, I should think. I remember my grandmother solemnly pointing to the old folk’s parade, and saying If you carry on climbing trees, that’s how you’ll end up. It didn’t do any good, of course. I didn’t agree with her then and I don’t now. I think climbing trees and the rest of it is what kept me fit. Up until now, of course. Any luck with the ... you know what?’
‘No. I’m afraid not. You’re going to need a specialist.’
‘Bad luck, mother,’ says Ethan, draining his cup and springing to his feet. ‘More tea?’

* * * 

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Sunday, April 24, 2016

gloria & the robot

When Lionel smiles it’s like the friendly gape of a wet-mouthed hound, the fleshy corners of his mouth a little sad and down.
‘Do come in!’ he says, but he doesn’t make quite enough room in the vestibule, especially as there’s another, inner door to open, and as I’m laden down with obs bag, weighing scales, folder and other things, we’re forced to do a little dance in the limited space available.
‘If you could just…’
‘I tell you what, if you…’
‘Of course….’
‘That’s it!’
We manage to get the door closed, and stand together in the main hallway, an impressive room, with a geometrically tiled floor, an ornamental fireplace, and a chandelier hovering above our heads like some elaborate, crystalline spaceship.
‘If you’d like to come this way,’ he says. I follow him through into the living room.
‘You have a lovely house, Lionel.’
‘Thank you. That’s so kind. It’s just me now, of course. I rattle around somewhat. I’m thinking of downsizing.’
‘Thinking about it! It’s hard to move when you’ve been in a place as long as we have. Sixty years, this autumn. But Gloria passed last year, so now it’s just me.’
‘I’m sorry to hear that.’
‘Yes. Well.’
He sits in his armchair, and begins turning his wedding band round and round.
‘It’s supposed to get easier,’ he says. ‘Time the great healer and all that guff. But you know, I don’t think it does. If anything, it gets harder.’
‘In what way?’
‘Well you see, to begin with I was so busy. There was lots to do. People kept coming round, family and so on. How are you coping, Lionel? Do you have everything you need, Lionel? Taking me places and so on and so forth. But that can’t go on forever. People have their own lives. So it all falls away rather, and you’re left to your own devices. It’s the little things that take you by surprise. I’d just finished reading this…’
He picks up a book on Hollywood from the side table. ‘And it just happened to mention The Day the Earth Stood Still. Have you heard of it?’
‘Absolutely! It’s famous.’
‘Oh! Then you may be interested to know that Gloria knew the robot.’
‘Or the man who played the robot, at least. When she was a student in California back in the fifties, she had a job selling tickets at Grauman’s Chinese Theater on Hollywood Boulevard, and the doorman there, a really tall chap, got hired to play Gort. I remember she said they were jealous as anything at first, but as it turned out, he didn’t have a nice time of it. Half suffocated to death in the rubber suit, by all accounts.’
He puts the book back on the table and folds his hands on his lap.
‘Now it’s just me, sitting on my own, thinking about robots.’

* * *

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Saturday, February 20, 2016

Follow the dog!


Thanks very much for visiting Siren Voices again.

I thought I'd put one last post up in a shameless attempt to persuade you to come over to It's much the same kind of thing - character studies (carefully anonymised), anecdotes, happy / sad vignettes... I think you might like it!

with thanks & best wishes,

Jim (Spence, as was)

Wednesday, May 06, 2015

the last post

So that’s it!

Nine years and one thousand posts later, I’m writing my last item as Spence Kennedy.

When I started Siren Voices I had no other ambition than to make a diary record of the people and situations I found myself in, to report what happened each time as sympathetically and non-judgementally as I could, and most importantly, to get myself into a routine of writing.

For a long time no-one outside the family read the blog, which wasn’t surprising, because I didn’t do a thing to promote it. But I kept going, and it was gratifying to see the word-count build up. I fiddled around with the style a few times, experimented with the voice. Innis, a good friend of mine (and a brilliant photographer), let me use some of his photos in the header. My writing style changed, and I started to feel easier about confronting the blank screen each time. The whole thing began to feel quite solid.

Still, nothing else would’ve happened if my wife, Kath, hadn’t emailed Suzi Brent at NeeNaw. Suzi recommended Siren Voices, and suddenly I started getting comments!

I was quite worried to begin with. I felt uneasy about writing under a pseudonym (‘Spence Kennedy’ because my mum’s dad’s middle name was Spence, and Kennedy because I was reading The Big Picture by Douglas Kennedy at the time). I knew how important it was to protect patient confidentiality, but I couldn’t think how I’d be able to maintain the degree of intimacy that I wanted if I had to ask a patient for permission each time. The easiest thing seemed to be to change identifying details and stay anonymous, even though I really wanted to be honest about who I was. In the end I decided to stay writing as Spence Kennedy. Years passed. I became two people: Jim Clayton at work; Spence Kennedy on-line. It all seemed to balance out. I didn’t want to do anything that might jeopardise the blog.

When it came to self-publishing my first books, I stuck to Spence Kennedy because I thought the only people who might feasibly buy & read them were the followers of the blog. It was frustrating not to publish under my real name, but then again, I figured that I wouldn’t be in the ambulance service all my life. When I left, I’d be free to pull off the mask and start writing as myself.

So that’s what I’m about to do!

My day job will be with the Community Rapid Response Service – working alongside Occupational and Physiotherapists, District Nurses and so on, helping patients avoid hospital and stay at home. I won’t be blogging about my work with the CRRS, although if I come across some interesting stories I might conduct a more open interview and get permission from the patient before I publish.

The new blog will be much more general, I think. A collection of sketches, poems, stories – anything that occurs to me. I’ll try to make it as entertaining and interesting as possible, with more pictures and clips than before. I look forward to hearing what you think.

I won’t be posting on Siren Voices any more, but I will keep the site open for people to read and comment on if they want. I’ll certainly publish any comments that come in, and make a few of my own. I’m proud of what Siren Voices represents: as true a picture of life on a front-line ambulance as I could make it.

There are so many people I need to thank, I hardly know where to start. My wife, Kath, for reading everything and editing it into some kind of meaningful order. Blogger has been a great platform and I recommend it thoroughly. But most of all I’d like to thank everyone who’s ever read, followed, commented or Tweeted about Siren Voices over the years. I really couldn’t ever thank you enough. I hope you all stay in touch, because I feel like I’ve made some good friends over the years.

Here’s to the next nine years!

Jim Clayton
(feels good to type that...)

Check out the new site:

nora, nine years on

I remember Nora.

Early summer, a high blue day in May, bright and full of hope.

Which made me feel worse, of course.

I’d been in the ambulance service a year, working the non-emergency side of things, ferrying elderly patients to and from day centres, outpatient appointments. I liked the work. It was therapy after training to be an English teacher in a secondary school and crashing out in my second year. I was a failure, on the run from myself, from the Smoking Ruins of my One Last Chance at a Career.

Something like.

I’d taken the whole teaching disaster particularly badly because I’d always thought of it as my Ace, the one, sure-fire card I could play if things got tough. When it turned out to be the Joker, I panicked.

To begin with, the regularity of patient transport helped me feel less anxious about things. It was simple, practical, obviously useful. I was in amongst an entertaining bunch of patients who eased my bruised sense of connection with the world. If I was hopeless at everything else, at least I could drive a bus, chat to people, wheel them about. I had plenty of time to read. I stared out of the window as the world flew by: pylons, houses, trees.
After a while I started to feel restless. I wondered what it would be like to work on a frontline ambulance. Maybe I could turn myself into the kind of person you got when you dialled 999, the kind of person who’d Be Cool and Sort Things Out.

I applied for the EMT course but there were delays. It was a frustrating process. Administrative snarl-ups, rules that changed overnight, interviews that went well but led nowhere – bureaucracy rising up like thorns round an enchanted castle.

In the meantime I started this blog. I’d always loved reading, and for many years I’d fancied I could write something. Every time I’d tried in the past, though, the project had fallen apart. I didn’t seem to have the tenacity to see it through.

A lack of sticking power. Someone said that about me once. Were they right? Was that the common denominator in my ho-hum working life so far?

Maybe writing a blog would help. A useful distraction at least, a way of cultivating a more objective view of the world. Focusing on other people was patently a good thing. I was too self-obsessed. I was like that guy in An American Werewolf in London, except when I fell screaming to the floor I wasn’t turning into a monster but a moany old git.

The other thing was that blogging felt like a useful way of sneaking up on writing, doing it without it being a thing. Blogging was endless. It was practical. It was audience-less, too, for a while, but at least it was ‘out there’. People could take it or leave it – comment, in time, if they wanted. I could desensitise myself to criticism. And I’d be spared the terror of the finish line, the crashing moment when something would be done, judged, found wanting.

I decided to blog about ambulance work. And as it turned out, Nora was my first subject.

I remember walking alongside her as she shuffled with sticks from the day centre to the ambulance. I was intrigued by her accent, by the aura of contrariness that bound her as tightly as her scarf. The nurses were scared of her. They smiled when I said goodbye, but I half-expected to see them cross themselves as they turned away.

An interesting case, I thought. I bet she’s got some stories.

I was attending, so I had plenty of time to grill her in the back. I’d get to hear all about it, the country she came from, the love affairs and hazardous escapes, the heartbreaking family break-ups, the inspirational recoveries. It was a long way back to her house. I’d get a comprehensive life history.
I made myself comfortable.
I made sure she was.
I was ready to be the chatty ambulance man, innocent, open, inquisitive. Ready to memorise the good stuff.
Nora was as brutal as a hip replacement.
‘Why do you want to know these things about me?’ she said.
'I'm just curious.'
'Well maybe I won't satisfy your curiosity.'

And that was that.

The rest of the journey I was back to staring out of the window.
Pylons, houses, trees.

When I got home that evening and sat down to write my first blog entry, I stared at the blank screen and rubbed my face. I reviewed the day, moment through moment, trying to visualise each patient, what they looked and sounded like, where we picked them up from – any angle I could think of. But the one who really stood out was Nora. For want of anything else to write about I gave in and wrote a short paragraph about what had happened.
Later, when I read it back, I saw that the reason she’d made such an impact was because she’d subverted my expectations. She hadn’t behaved like I wanted her to behave. Despite my best efforts she was simply Nora. Crotchety, complaining, cussed old Nora: headscarf, two-sticks, murderous demeanour.
I carried on and wrote a few more, one a day. And when I felt brave enough, I posted them.
There were no comments, of course, but I didn’t mind. I’d made a start. I was getting myself into a habit of writing, a habit of thinking about writing, and it felt good.

Nine years on, I can still feel Nora’s eyes on me in the back of that ambulance, the icy pause before she said:
‘Well maybe I won’t satisfy your curiosity.’
I suppose as a first subject, it’s ironic that Nora was so flatly uncooperative. But like it or not she’s there at the beginning, a quirky kind of guardian, perhaps. Cerberus in a Headscarf, focusing her fury, challenging me to get past with what little I had, to struggle on regardless and get something written.

I suppose, as figureheads go, that’s actually not too bad.

Saturday, April 25, 2015

moro reflex

We’re on our way to a routine job when we spot them: two men, struggling to help up an elderly man who’s sitting on the pavement. They’re looking around for help, presumably to ask someone to phone for an ambulance.
We pull up alongside. I open the cab door and climb out.
‘What’s happened?’
The first guy takes a moment to register who I am, stunned by the fact he’s only had to think about an ambulance for one to show up.
‘Can you help us?’ he says, struggling with the guy, an old man in a khaki cap and shiny overcoat. There’s an unzipped holdall beside him on the pavement, the neck of a bottle of whisky poking out of the middle, conveniently to hand.
‘Did you see him fall?’
‘No. He was just lying there. No-one else seemed that bothered.’
‘Can you take over?’ says the other guy.
‘Sure! We’ll be fine, now. Thanks for your help.’
‘No worries,’ says the first. I thought they were together, but after exchanging a brief, rather surprised look, they walk off  in separate directions.
After we’ve reassured ourselves the old guy hasn’t hurt himself, we help him up and, guiding his legs giant-puppet-style, we walk him up the ambulance steps and land him safely on our trolley.
Rae fetches in the holdall.
‘There! That’s better! Now then. My name’s Spence. This is Rae. Can I ask what your name is?’
His head lolls from side to side, his eyes open but unfocused.
‘What do we call you?’ I ask him again. ‘Hey?’
He turns his face in the approximate direction of my voice and opens his mouth to talk – or rather, he tips his head back and releases a gargle of unshaped sounds, floating out on a cloud of vapours. Once he’s decided enough noise has been made to satisfy the request for information, he stretches his lips a little more to reveal a motley collection of stumps, and laughs.
‘Harr harrrrrrr!’
Even if it wasn’t for the bottle of whisky you’d guess he was drunk. A distillery would smell sweeter.
‘George!’ says Rae, who’s found a bus pass in the holdall.
‘S’it,’ says George, his head wobbling so dangerously if it wasn’t for the roll of blanket behind him it’d be in danger of falling right off his shoulders. ‘Orrargh!’
The effort of saying his own name exhausts him. He deflates into sleep, slides a little down the trolley, his cap pushed forwards across his face.
I give him a pinch and take his cap off, and he’s suddenly awake again, paddling his arms in the air like the Moro reflex in a baby.
‘Marrghm!’ he cries out, his eyes wide open again, staring up at me.
If he thinks I’m his mum, no wonder he’s surprised. Given his age, she must have been dead these past twenty years.

Monday, April 20, 2015

so far so good

‘They wanted to call an ambulance but I said no, don’t bother, I don’t want one.’
‘You didn’t want one?’
‘No. I didn’t want the fuss.’
‘I must admit I’m surprised.’
‘What – that I didn’t call an ambulance?’
‘No. That the gym didn’t call one anyway. I mean, there you are, collapsed on the treadmill, vomiting everywhere. How did they know you weren’t having a heart attack or something?’
‘I didn’t have any chest pain, Spence.’
‘But still...’
‘I knew what it were. I just overdid it.’
Moira looks fine now. A vivacious, middle-aged woman, dyed orange hair, purple sunglasses, as confiding and friendly as a counsellor or librarian, but dressed for action in a yellow tracksuit top, red jogging bottoms, and a t-shirt that says: Pain is temporary; victory lasts forever.
‘Let me tell you a little bit more,’ she says, shifting in the chair. ‘I had the gastric by-pass a month ago.’
‘A month!‘And you’re down the gym already?’
‘Yes. Well. I wanted to crack on, Spence.’
‘What was the guidance they gave you about exercise post-op? If you’d had a caesarean you wouldn’t even be driving for ten weeks, let alone pounding away on a treadmill.’
‘I weren’t pounding nothing, Spence. I was taking it relatively easy. It’s a clever machine, you know. You get to pick the incline, the speed and all the rest of it. It’s not like I were running a marathon.’
‘But still...’
‘You see, Spence, once I’d decided to lose all this weight, once I’d set my mind to it, I just wanted to get on and do it. Look!’
She stands up, takes off her tracksuit top, and holds her arms out.
‘Five feet tall and seventeen stone, I was. Well, I’m still five feet, but look! Look how much has come off already!’
With her right hand she waggles the loose flesh below her left arm.
‘I’ve got the bingo wings from hell, but don’t worry, I’ll get advice on them in a bit. I’ve got some photies somewhere, Spence. I was proper big.’
‘I think you’re doing an amazing job, Moira. I’m just a bit worried you’re taking it too fast.’
‘Yeah, but when you want something, you want it, don’t you?’
‘Didn’t you have an induction at the gym? Did they know about your surgery?’
‘Well, they did and they didn’t. I told them I’d had some abdominal surgery, but I were too embarrassed to tell them what it was. I just said it was personal. Something that meant I had to have internal stitches. So they said fine, no worries, it just means you can’t go on the rowing machine or them ones where you work up and down like this, with weights on the end and all that.’
‘Because at the end of the day they don’t want to get sued.’
She sits back down and has another sip of water.
‘I have to say they’re a nice bunch, Spence. It’s not one of them places stuffed full of mirrors and glamorous bodies in stringy nightmares making you feel like a bloody fail whale. They’re pretty good.’
I finish writing the paperwork.
‘Can I get you anything?’ she says. ‘Some yoghurt? I’ve got yoghurt coming out of me ears.’
‘That’s kind of you, Moira, but I’m good. Well, look. You seem fine now, your blood pressure, blood sugar, temperature, ECG and the rest.’
‘I know. That’s why I didn’t call the ambulance at the gym. I knew if I got home I’d be okay. Lucky I had a change of clothes, though. The taxi would’ve taken one look at me and driven off at speed.’
‘I think it’s probably a good idea to make an appointment to see your GP, Moira. Just to review where you’re at, give you some advice about exercise and diet. I’m no expert, but I think you should probably go at this a little more gently. You don’t want to set yourself back.’
‘I’m sorry to have dragged you out for nothing, Spence. It weren’t me that called. It was my son. He rang that advice line, and they said they’d be sending an ambulance.’
‘I’m not surprised.’
‘Sam’s a good boy. He’s a bit shy, though. That’s why he hasn’t come out of his room.’
‘Will Sam go with you to the doctor’s?’
‘No. He’s got to go stack shelves at the supermarket. The graveyard shift. Just till he gets himself sorted.’
I hand her the patient report form.
‘You can show that to the doctor if you like.’
‘Thanks, Spence.’
‘So I’ll say goodbye now. Good luck with the diet. And take it easy. Don’t set yourself back.’
‘I won’t.’
She laughs, and flexes her arm.
‘So far so good!’

come with a net

Agnes is lying on the floor where she slipped out of bed sometime in the morning. She hasn’t hurt herself. There’s plenty of room and she has some strength in her arms and legs, so it’s an easy thing to use the inflatable cushion and get her up. She stands, stiffly but well enough, walks unaided into the front room where she sits in her chair with an appreciative sigh.
‘That’s better!’ she says. ‘I’ve landed!’
Ian, her PA, watches from the doorway.
‘This can’t go on!’ he says. ‘You didn’t have your alarm on again. What have we said? Why didn’t you have your alarm on?’
Agnes looks at me and winces.
He’s off again! she says.
Ian folds his arms.
‘It’s all very well you saying this stuff but it’s not going to make things better is it? I’ve been on and on at the daughter but she won’t listen. Agnes has been falling a lot lately. She won’t use her frame properly, she forgets to wear her button. Her memory’s shot and I don’t get any extra help. I’ve had endless arguments with her but it doesn’t do any good...’
He steams on in this vein. I ask him to fetch in Agnes’ medication, just to get some space to ask Agnes if everything’s all right.
‘Don’t mind him,’ says Agnes. ‘He gets a bit worked up sometimes.’
It’s a strange situation. The flat is neat and tidy. Agnes seems happy enough in herself, and we haven’t seen any signs of bruising that might indicate physical abuse. She’s warm, well-fed. There are rails on the walls, a wet room, toilet surround, walking aids. The daughter’s already been on the phone. She sounded caring, interested, in touch. Ian’s stress seems completely disproportionate.
He comes back in with the blister pack and hands it to me. His face is taut, waxy; his expression guarded. I wonder for a minute if he’s about to cry, but he launches into another bitterly intense description of the state of affairs. I have to speak over him to have a chance of asking specific questions, or finding out how things stand.
‘What’s the difference between a Personal Assistant and a Carer?’ I ask him.
‘Nothing. Nothing at all. It’s exactly the same job, for what that’s worth, except it’s a private arrangement between me and the daughter. I used to work for an agency, but they took me on full time, shoot me now. It’s just me, doing everything. The daughter comes round now and again and gets in the way. Quite honestly it’s a miracle I get anything done. I don’t think she realises...’
‘It must be very stressful for you,’ I tell him. ‘You’ve obviously got a lot on your plate.’
He launches into a long, scattershot complaint, covering everything from shopping arrangements to difficulties with the new bed, missed appointments, misunderstandings, unsatisfactory consultations with the doctor – and at every point, standing at the margins of his unhappiness like some malign shadow, the figure of the daughter.
Ian must at one point have been a good match for them as a family. There’d be no other reason why they’d take him on as the single carer for the mother. But it’s hard now to see why that would have been the case – and equally hard to understand why he’s still there. Surely the daughter can’t be unaware of his level of discontent? Or is this new today?
I suggest to Ian that we make a Falls Referral. I tell him I’ll make a note that the level of care also needs looking at.
‘Good luck with that,’ he says. ‘It’s not as if I haven’t tried.’
‘Well it can’t hurt if we add our voice.’
We say goodbye to Agnes and head out.
Ian follows.
‘I need a smoke,’ he says.
He goes as far as the grass verge, then lights up and starts pacing around, shooting us glances, smoking furiously, intermittently checking his phone.

‘Oh my God!’ says Rae. ‘What’s he like?’
‘Maybe I should phone the daughter?’
‘It’s difficult, isn’t it?’
‘Or do a Vulnerable Adult report? But that gets social services involved, and she doesn’t seem all that bad.’
‘The Falls Team are pretty good, though.’
‘I’ll make sure I put some notes on the job.’
‘Yeah – like come with a net.’
I make the referral. I’m a little uneasy about the whole thing, but at least someone’s coming in. After all, maybe this is just a particularly bad day for Ian, and we don’t want to stir things up unnecessarily. It’s never clear cut.
When I’m done I put the clipboard on the dash, glance over to Ian again and wave.
He nods, takes one last drag of his cigarette, flicks it away into the road and then exhales such a cloud of smoke it looks for a moment as if his head has exploded.
Then he turns and marches back inside.

Sunday, April 19, 2015

sign your name

Ken’s heart is skipping like a syncopated jazz score. It’s almost certainly the reason he collapsed. For some reason the on-demand pacemaker he had fitted just a couple of months ago hasn’t kicked in, so we’re taking him to hospital to have it checked.
‘Ever since Ruth died I’ve been treading water,’ he says. ‘I don’t want to drag on too much longer. Sixty years we were married. And that’s a very long time.’
He lifts his head from the pillow, lowers his chin and stares at me over the rim of his silver glasses. ‘Sixty!’
He rests back, laces his fingers across his belly, and closes his eyes.
‘I met her at a dance when I was on leave. There were three of them and I went straight for the pretty one in the middle. I said Are you dancing? and she said Well I suppose I better had. And that was that. She was the most wonderful woman you could ever meet. I knew a good thing when I saw it. We got married a couple of months later. Well – you didn’t hang around in them days. And after the war, we were never apart. Not once.’
He flexes his jaw, like he’s testing the shape of the words he’s about to say.
‘I can’t believe she’s gone. Still – I won’t be far behind.’
Sunlight flickers in through the slatted ambulance windows. There’s a warm and boxy feel to the afternoon, closed-in, sleepy.
I ask him about all the paintings back in his house. Watercolours of harbours, fishing boats, country scenes, churches.
‘I used to teach painting,’ he says. ‘Adult education, art clubs, that kind of thing. And then I’d be off with my easel somewhere, and sometimes there’d be a little crowd gather, and I’d end up putting the picture aside and giving a lesson instead. I remember one time, I taught a group of kids who’d been getting into trouble. They weren’t bad kids. They just needed something to do. So I took them outside in the fresh air and I sat them round this big old oak tree and I got them to paint what they saw. There was this one kid, the roughest of the lot, a real scrag-end. And he did a marvellous picture, full of energy and colour. And I said to him “Is it finished now?” and he looked at it for a minute or two and he said “Yep”. And I said “Are you sure about that?” and he said “Yep”. And I said “Are you absolutely, one hundred per cent, positively sure there’s nothing else at all you could add to this picture to finish it off?” So he looked at it for another minute. And eventually he says “I said it’s finished so it’s finished, all right?” “Okay, then” I said. ‘Right!’ So I leaned over and I wrote my name in the corner of it and I said “Well you won’t mind me doing that, then, will you?” He knew what I meant. We had a good laugh about it.’
Ken shakes his head, then turns and gives me another stern look.
‘Sign your bloody name!’ he says. ‘Always! It’s yours and no-one else’s!’


Cara, Jake’s support worker, is waiting for us in the lobby of the health centre. As soon as she sees us walking up the path she brings him out to meet us. They’re a curious pair, both middle-aged, but whilst Cara is neatly dressed, bright and sharp, clipping along in a hacking jacket, ethnic scarf and pixie boots, Jake is rolling beside her, morbidly obese, covered rather than dressed, everything black – black t-shirt, black tracksuit bottoms, black anorak, the striking blackness of it all emphasising the pallor of his face.  
‘I can’t go there,’ says Jake. ‘It’ll be ten o’clock soon. I have to have my cup of tea at ten o’clock. How am I going to get back in time?’
‘Don’t worry about it,’ I tell him. ‘They’ve got plenty of tea at the hospital. They’re good for that.’
‘I’ve got OCD,’ says Jake. ‘Anxiety and panic attacks. I’m going to need a Diazepam or I’ll lose it, I know I will,’
‘One step at a time,’ says Cara. ‘We’ve really got to get your leg sorted out.’
‘I don’t care about my leg,’ says Jake. ‘I want to go home.’
Jake seldom goes outside his flat, or even out of his chair. On top of all his other health problems he’s suffered a DVT. The doctor has ordered him straight into hospital for a scan, but even though Jake’s left calf is as tight as a red balloon, covered in a pruritic rash he’s scratched into a scabby mess, he’s still reluctant to come with us. We have to tempt him onto the ambulance with a string of blandishments, keeping him talking whilst we quietly put on his seatbelt and gently pull away. With me one side and Cara the other, we keep him in a cross-fire of reassurance for the short journey in.
‘How long will I be up there?’
‘It’s hard to say. It’s not too bad at the moment so it’s a good time to go.’
‘I can’t sit around and wait for hours. Will they see me straight away?’
‘They’ll certainly do their best to sort you out as quickly as they can. They need the space!’
‘I can’t be waiting for hours and hours. It’s too much for me. I want to go home. Why can’t you take me home?’
‘You’ve done really well getting this far, Jake. Just try and take it a little step at a time. You made it to the doctor’s, which was brilliant. And now you’re on the ambulance going to the hospital, which is fantastic. One step at a time.’
‘I think you’re doing brilliantly, Jake.’
‘Yeah but I don’t want to go to the hospital. Take me home.’
‘We can’t take you home, Jake.’
‘Why not?’
‘Because your leg’s in a pretty bad way. If you don’t get it treated today you could suffer complications.’
‘What do you mean, complications?’
‘A clot could go up into your lungs and stop you breathing.’
‘I don’t care if it does.’
‘But we do, Jake.’
‘Just take me home.’
‘We’re not allowed to.’
‘Okay. Drive me to a cliff and throw me over.’
‘We care about you too much to do that.’
‘I don’t, and I don’t care about my leg. Why would I care about my leg when I don’t want to live?’
‘I’m sorry you feel like that, Jake. I know this is difficult for you. But if you come to the hospital we can get your leg sorted and then find you someone to talk to about your low mood and how things are generally.’
‘I don’t care about any of that. Just take me to a cliff, throw me off and be done.’
‘We’re not going to do that.’
‘Why not?’
‘Jake. Try not to worry. Look – I’ll make you a nice cup of tea when you get to the hospital. How about that?’
‘It’s not the same. I need my special cup. I need to be home.’
‘Getting your leg sorted isn’t something we can do at home, though.’
‘Why not?’
‘Because of all the special machinery, the ultrasound scanners and what have you. All the specialist staff that are involved.’
The ambulance rocks violently as we turn up the ramp into the A&E car park.
‘We’re here!’ I tell him. ‘Well done!’
‘But I don’t want to be here,’ he says.
‘Come on, Jake,’ says Cara, holding out her hand to him at the bottom of the steps.
Eventually he gets up and moves to the back of the ambulance. He stands in the doorway with his hands either side, staring out, massive, bloodless white, taking in the horrifying activity of the ambulance bays, the fuss and clamour of it all, like an albino Orang-utan being coaxed out of the forest into the city.
‘I want my tea,’ he says.