April’s dog Ken is curled up on a leopard-pattern cushion the far side of the sofa. These days he doesn’t even look up, he’s so used to crews coming through the door, all hours of the day and night. It’s a shame he doesn’t look up. It’s always a pleasure to trade glances with those kindly black eyes. Ken is one of the most photogenically scruffy terriers I know, a generous scrawl of extra fur at the end of his muzzle, which, along with his neat build and fancy blue neckerchief, make him look like a famous author resting before another exhausting round of book signings.
‘Don’t get up’ I tell him.
April suffers from asthma and recurrent chest infections. The fact that she smokes doesn’t help, firstly because the very last thing her damaged lungs need is smoke, and secondly because it means she can’t have home oxygen. So April is on a loop of treatment every bit as chronic as her condition. She has a cigarette, she struggles to breathe, her inhalers are ineffective, she calls for an ambulance, she responds to treatment or gets taken in for more, depending. Every crew knows the score, but if you haven’t been here much it’s easy to be spooked by the way she presents, unable to speak, the laboured way she breathes, the dreadful wheeze. It’s difficult to resist the urge to treat and move as soon as possible, especially when you read on previous sheets that she’s spent time in ITU with the same. The fact is she does respond, though. She never wants to go to hospital. She wants to stay home, curled up on the sofa with Ken. And no-one can blame her – or for smoking, come to that.
It’s the kind of estate that would have the Dalai Lama tearing the strip off a new pack of Lights. On a notoriously run-down estate, in a tributary of particular awfulness, the close April lives on is a strandline of three storey buildings, many of the flats shuttered up and empty, the communal gardens a no-man’s land for dogs, drunks and dead appliances. It’s a wonder all she does is smoke – and watch DVDs, and snuggle with Ken, and call the ambulance.
We fix her up a neb of Ventolin and Atrovent, and wait for her SATs to improve. I write her sheet out from memory. Not so long ago, in a dizzy rush of ‘let’s fix this’ enthusiasm (now and again I’ll feel it, a gloriously ludicrous urge to jump on my horse and charge the cannons), I tried sending some emails and making some calls. What does the GP make of all this? The Community Respiratory people, the psych team? Are they fully aware? Everyone’s getting it in the neck. Surely there must be something we can do to cut down the number of calls?
‘Honestly – there’s a stack of ambulance sheets about three feet high,’ I tell the Clinical Desk. ‘And that’s just this year.’
‘I know,’ says the paramedic the other end. ‘Let’s have a look at her record. Here we are – averaging two call outs a day every day, except when she’s in hospital. That’s pretty impressive.’
‘So what do you reckon?’
‘I don’t know,’ she says. ‘Perhaps we could move in. At least we’d save on diesel.’
April’s breathing seems okay now – or better than it was, at least. Still wheezy, but not as bad. She says she’ll see her GP and talk about how things are going when the surgery opens later.
The other end of the sofa Ken takes one of those unexpectedly deep breaths that dogs make when they’re absolutely, fully and most completely relaxed. He licks his chops a couple of times, settles another inch
‘Good boy,’ says April, reaching over to tickle him on the side.
The dog rolls over, exposing a luxuriously furred underbelly. April tickles him there.
‘All right then?’
I add my sheet to the others. Tidy up.
‘See you later.’
April, Ken and me - we know it won’t be long.