options

Mr Warding, BEM, DCM, DL, is sitting on a rich leather sofa in the lounge, one arm in a blood pressure cuff and the other on the armrest, wired up for an ECG, his shirt unbuttoned to the navel, his velvet-lined jacket slung neatly across his lap. Two of the residential home staff hang back, one with a folder of notes, the other with a bag of medication. Stephen, the first paramedic on scene, is just finishing his examination; he introduces us to Mr Warding, then carries on.

‘So - to re-cap for these guys,’ he says, ‘you’d just finished lunch, you felt a bit swimmy, you were helped to the sofa where it looks like you may have passed out for a minute or two. At no time did you have any chest pain, and you don’t have any now. Is that right?’

‘Ye-es. That is correct. Now look here. What’s going to happen to my wife when I go in to hospital? She has some significant health problems of her own, as you no doubt have been informed by these good people here to my left and my right. I am her main carer, although to be frank my responsibilities are pretty light, limited to a few words of conversation, perhaps a little push around the gardens in her wheelchair. But you see even that is rather too much for me these days. I’m interested to know what you recommend we do about this?’

Mr Warding speaks slowly and precisely. Whenever he needs more air he stops, squeezes his eyes shut and pulls a peculiar expression, a cute and animal thing, a cross between a smile and a stifled sneeze. With his hanging jowls, great, fleshy paws and stubby legs, he could be a gigantic species of mole, ninety-five years old, reminiscing about the lawn.

‘Has something like this ever happened to you before?’ asks Stephen, writing down the last of his observations, then putting the board down, unwrapping the cuff, disconnecting the leads.

‘Well in actual fact it has. (Smile). It was very much the same circumstance, a post-prandial fainting fit, barely a week ago. (Smile) I was assisted to this sofa, made comfortable with cushions and so forth, water and the like. An ambulance was dispatched and duly arrived (Smile) They trussed me up with wires and so on, as indeed you have, and they found absolutely nothing wrong with me at all. (Smile). They recommended I travel with them to the Accident and Emergency department of the local hospital, and I followed their advice. (Smile) As one should. (Smile) More tests, more collective scratching of heads. I was there quite some hours. It was dark when I was finally delivered back to my room, with no more insight into my condition than before.’

Stephen has packed away all his things and looks about ready to force a decision.

‘So, Mr Warding. All things considered I would imagine you had a simple faint. I don’t think it’s your heart, but of course that’s just a guess.’

‘A guess? Well, now, I’d like a little more than guess work, if you wouldn’t mind. (Smile) What I’m really after are some definitive answers. Something I can hang my hat on. I can’t very well carry on like this, you know. Collapsing about the place for no good reason.’

‘When I say guess,  I mean an educated guess.’

‘An educated guess. Yes. I see.’

‘Based on what I’ve found. Which is nothing, to be blunt. But obviously I can’t do blood tests, and I’m not a doctor.’

‘No.’

‘You have plenty of carers around you, Mr Warding. One of your options would be to stay here at the home and see how you go. If anything changes, you can always call us back again. Or else you can go to hospital with these guys, and go through some more tests. And see a doctor, of course.’

‘Well, now, that’s most interesting,’ says Mr Warding, ‘Thank you.’ He fiddles with his gold cufflinks. I’m amazed he can handle such small things with those paddle-sized fingers, but he seems to manage okay. With his sleeve restored, he carries on.

‘You think I should go to the hospital and see a doctor? Well – of course my over-riding concern would be my wife. Who would be there to take care of her whilst I’m away seeing these doctors and having all these tests?’

‘Or you could stay here with the care staff and see how you go.’

Both women step forward. I half expect to see them curtsey.

‘We’ll keep a close eye on you, Mr Warding. And Mrs Warding.’

He glances at them both, then sighs, and sinks about a foot further into the chair.

‘It’s not as if she does all that much,’ he says. ‘Dementia, you know. A terrible business. Mostly she just sits there, staring. But then again, often she carries on awfully, crying out, you know? Making a dreadful show of it. I don’t know what to do. I simply don’t know what to do.’

Stephen has shouldered one of the bags and has the other in his hand. He stands over Mr Warding, willing him to make a decision.

A grandfather clock gently tings the quarter.

A blackbird chip-chip-chips out in the garden.

‘Now then,’ says Mr Warding. (Smile)  ‘What are my options?’