Eleanor has a field of anxiety around her as palpable as mains hum. Her features are slack, a wattle of loose flesh under her chin emphasizing each tremor and tremble, each nervous flick of attention and concern.
‘I have to get it sorted,’ she says. ‘I can’t go on like this.’
Her brother, Ralph, is anxious, too, but as a thinner, more active man, the quality of his worry has a defined and cartoonish quality. His home-cut hair sticks up like he’s just stuck a fork in a toaster; his teeth protrude from his mouth in an alarming dental flare which his tongue passes over from time to time.
‘Save your breath,’ he says, patting her hand. ‘Don’t exert yourself. You know what happened last time.’
Last time turns out to have been yesterday. And the day before that. And the day before that. A quickening pattern of acopia spreading through the preceding months.
Eleanor has asthma. She’s on a conservative regime of medication, and it would appear to be adequately controlled. Eleanor felt short of breath this morning. She has a nebulizer in the front room, but the line doesn’t reach to the bedroom and she didn’t feel able to walk through. So she used her Ventolin and called 999. When we arrived all her obs were okay, she had no wheeze or worrying chest sounds of any kind, and she could certainly talk quite freely. Normally we would refer back to GP, but when I suggest it the response is prolonged and emphatic.
‘Useless. Absolutely useless.’
‘He never comes out.’
‘You never see him.’
‘How am I supposed to get down there?’
‘And when you do he always says the same thing.’
‘Don’t work yourself up, Eleanor.’
‘I can’t help it.’
‘Save your breath.’
And so on.
I make one last effort to persuade her.
‘You see, A&E is really for people who are acutely unwell, Eleanor. Your condition is more of a chronic thing. I don’t blame you for calling the ambulance when you were feeling short of breath – that’s perfectly understandable. You did the right thing. But now it’s all settled down, you’d be better off seeing your GP and talking through all the options there might be to help you cope better at home. The respiratory team, community health, that kind of thing. What do you think?’
‘I want it sorted. I can’t go on like this.’
‘But hospital isn’t really the place.’
‘Are you saying my sister should not go to the hospital if she wants to?’ says Ralph, moistening his teeth and then turning his mouth into a tight and approximate smile.
He looks tired.
They both do.
‘You’re perfectly within your rights to go to hospital if you want to, Eleanor. I’m just saying I don’t think it’s the right thing to do in this case. Your doctor is the person to co-ordinate a higher level of home care if it’s needed.’
‘He says I shouldn’t go,’ says Eleanor to Ralph, as if she’s having to translate. ‘What do you think?’
‘I think you need sorting out,’ says Ralph. ‘This can’t go on.’
I shift in the chair, and try a different angle.
‘What did they say up at the hospital when you were there last time?’
‘Nothing. They said I didn’t have a chest infection, that it was just my asthma, and I should carry on as normal. But are you telling me this is normal? Is it?’
‘Save your breath,’ says Ralph, patting her on the hand again. She moves it away onto her lap.
‘What do you think I should do?’ she says to me.
‘I’ve told you what I think. I think we should phone your doctor and arrange an appointment for him to come and see you.’
‘But he won’t get here till the afternoon.’
‘You’ll be okay till then.’
‘I wasn’t earlier.’
‘No, but you’ve got your meds, which seem to work. And Ralph’s here to keep an eye on you.’
‘I’m always here,’ says Ralph. ‘You know that.’
‘I don’t know what to do,’ she says, resting her head back and closing her eyes. ‘I just want to get it sorted.’
‘If you need the hospital you should go to hospital,’ says Ralph. ‘They’ve got a chair. They can carry you out.’
‘I don’t want to be a nuisance,’ she says, looking at me again.
‘You’re not a nuisance, Eleanor. We’re absolutely here to help. But sometimes that means taking a moment to figure out the best thing to do.’
‘Oh Ralph!’ she says.
He stands up.‘It’s absolutely no use going down the doctor route. We have to get this sorted. Today. So I’ll get your things together,’ he says, then turns to me, closing his eyes and raising his eyebrows, like a fraught and only marginally restrained teacher confronting a child: ‘If you would be so kind as to fetch in a chair.’