Joseph would make a passable bear. A grumpy, greasy, not-afraid-to-talk-his-mind kind of bear, most active in the small hours, crashing about in his cave whilst the city lies cold, blue and anonymous a million miles away at the bottom of the world. There’s definitely a sense of isolation in Joseph’s cave, a sense that the ornaments in his sparsely decorated cave are a little too dusted, a little too symmetrical (so much so that the millimetre difference between the three bronze owls with the wildly staring eyes on shelf one, and the identical owls on the shelf immediately below, is as shocking as if someone had taken a hammer to the place).
‘Have you had any contact with the Community Respiratory Team, Joe?’
‘We had words. They’re not coming no more’ he growls, shifting his position in the chair to free up a paw. ‘I’ve always been independent. I’m not about to stop now.’
The fact that his independence is equivalent to at least one ambulance a day, frequently more, and numerous (pointless) attendances at hospital, is something he cannot or will not grasp.
Each call takes exactly the same path. He hyperventilates. He self-nebulises over the course of a few hours with Salbutamol and Atrovent, until his anxiety is pumped tight as a balloon with the black word ANXIETY expanding and distorting bigger and bigger till it’s fit to bust – then he dials 999.
Just about everyone has made the journey up to this cave. They’ve all sat on this brown velour rock, had the same conversation, made the same calls. They’ve all tried to take it further, ramping it up to the level of vulnerable adult, sending off emails, leaving messages. But there’s only so many times you can do this and see that nothing changes before your enthusiasm to make a fuss wanes.
And of course this pro-active approach is dependent on the time of day. Early on in the shift you have the energy and ambition to pursue these things. Later on in the twelve hour stretch when your inner resources are depleted, when you’re too tired and greyed out to think about the bigger picture, that’s when you cut the conversation, set up the chair and haul him off to the ambulance, knowing full well he’ll self-discharge after a couple of hours, knowing full well he’ll lose his meds and other property, and grump his way back to the cave, paws heavy by his side, hairy palms backwards, when he’ll ride the lift back up to his cave, and slowly shut the door, and call again after a few hours.
‘It was a bad COPD yesterday,’ he growls, putting together another one of his home nebs. ‘A bad one. Them Community nurses, they don’t care I’m dying. We’ll be out in a couple of hours they say. What’s the good of that?’
He snaps the caps on a couple of vials of salbutamol and squeezes their juice into the acorn of another neb.
‘Don’t forget, COPD is a chronic condition, Joe. The respiratory team are there to help you cope at home.’
He straps the mask on, then jabs the table top with a finger to emphasise each word.
‘They – don’t – understand!’ he shouts through the mask. ‘They’ve got – to take – me seriously!’
‘Joe? Remember what we said? You really shouldn’t be using these nebs. You don’t need them. It’s only making things worse.’
He stares at me over the rim of the mask, his most severe, grumpy bear stare, then he reaches out and flips on the compressor with a claw.
The vapour spits and hisses out of the sides of the mask. He stares at me through the mist, his fury with the world made visible.‘I’ll get the chair,’ says Rae.