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.

‘George?’

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.

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.’

‘Exactly.’

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.

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!’

tea

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. 

the house at the end

Rae is sitting on the arm of the sofa, one hand pinching Irene’s nose just above the nostrils.

‘A couple more minutes then we’ll see if it’s stopped,’ she says.

‘Righto,’ says Irene. She obviously wants to chat despite her predicament, the wad of tissue she’s pressing underneath her nose, and the claggy effect of the blood and saliva in her mouth.

‘I’m in your hands,’ she says.

‘Hand,’ says Rae.

There’s not much else to do but wait. I’ve taken some obs, written out the paperwork, cleared away the small mountain of bloody tissues that Irene had piled up on the coffee table in the hours before she phoned. The Warfarin she’s taking is a factor. She was only up the hospital a week ago with the same thing. They didn’t cauterize then, but warned her it might need doing if it happened again.

‘It’s such a bloody nuisance,’ says Irene, then grunts and gestures with her free hand to the tissues on the coffee table. ‘As you can see.’

‘This is a lovely house,’ says Rae, swapping hands to give herself a break, turning to face the window,  motes of dust floating in and out of the bright lines of sunshine. ‘How long’ve you lived here?’

‘Oh, I should think about sixty year,’ says Irene, breathing through her mouth, her teeth outlined in red. ‘Just after we got married.’

‘Amazing!’

‘I was born in this street. Well – the house at the end.’

‘Oh yes?’

‘It’s not there now, course. We got bombed out in the war. I don’t remember all that much about it. I was in bed at the time. Everyone else was killed. Mum, my sister Joan, the neighbours either side. I went to bed one night and woke up in hospital. I was there for months, but they fixed me up. I was all right in the end.’

‘Oh my god! What about your Dad?’

‘Dad? Oh - he died just after the first war. I never really knew him.’

‘What happened when you came out of hospital?’

Irene shrugs, glancing up at Rae through her blue-gloved fingers.

‘I got a job in a laundry,’ she says.

‘That’s terrible,’ says Rae, shaking her head. ‘Not the laundry job. I mean the rest of it. Now then – shall we see how we’re doing.’

She releases her grip and kneels down in front of Irene, who tentatively lowers the tissue.

Unfortunately, the clot that had formed in Irene’s nose has bonded with the tissue. It extends in a bloody string then flops out into her hands, followed by a steady stream of drips that I staunch with some gauze.

‘I’m afraid it’s the hospital,’ says Rae, tying on a nose bolster.

‘I thought so,’ says Irene. ‘Look at me. What a two and eight!’

faux pas

‘Please don’t do anything. It’s not what she would have wanted.’

‘Is there a DNAR?’

‘A what?’

‘A Do Not Resuscitate order. Without that I’m afraid my hands are tied.’

‘Oh...no.’

Sheila is in cardiac arrest, and the paramedic doesn’t have the luxury of debate. Sheila’s daughter Rachel is too elderly herself to help, so she leaves the room and he sets about getting Sheila onto the floor by himself. Luckily she doesn’t weigh much. He’s able to gather the bottom sheet and slide her out of bed in a controlled way. As soon as she’s on the floor he starts chest compressions.

When we arrive a few minutes later Angus has cut Sheila’s nightie off and put the defib pads on. She’s in asystole, and stays that way despite all our efforts.

We stop the resus after half an hour. Tidy her up. Put her back to bed.

Rachel is sitting on the sofa with her husband Geoff when I go in to tell them that Sheila has died.

‘I knew she’d gone,’ she says. ‘We live in the flat just below. I should’ve known something was wrong.’

Her husband squeezes her hand.

‘I’ll make us all some tea,’ he says, and goes off into the kitchen.

‘She always said she didn’t want a long illness, in and out of hospital like Grandma,’ says Rachel. ‘She was a stubborn old thing. She had a habit of getting her way in the end.’

I tell her about the next stage, how the police always attend an unexpected death – ‘...purely routine, nothing to worry about. They’re only here as representatives of the Coroner’s Office. They’ll talk you through the next stage.’

It’s still early. Rachel and Geoff are in their dressing gowns. When he comes back into the room with a tray of tea things he sets it down on the table and says they’d better go back downstairs and get dressed.

‘You’ve got plenty of time,’ I tell them as they leave. ‘The police will probably take half an hour or so.’

Whilst they’re gone we tidy up some more, drink our tea, finish the paperwork. We swap gossip with Angus, then he leaves us to it.

As situations go it’s pretty perfect. The elderly mother in the upstairs flat, independent but still a daily part of things; the daughter and her family just below. It’s a bright and tidy place, filled with family pictures, from the slick-haired young pilot standing by a Spitfire with his arms folded, through black and white baby photos, prams in parks, faded colour scenes of weddings, graduations, increasing family groups in gardens so bright the colour has faded almost to white, outings, Christmas gatherings, parties in crowded halls, all the faces turned towards the camera.

Rachel comes back in – a little hesitantly, like it’s not quite the room it was.

‘Thanks for everything you’ve done,’ she says. ‘Can I ....go in and see her now?’

‘Of course.’

‘How’s the tea?’

‘A lifesaver,’ I say, immediately regretting the faux pas. Thankfully she doesn’t hear me, though. She’s already turned and headed back across the hallway. She hesitates by the bedroom door, gently opens it in the way that you would if you wanted to go into a room without waking someone, then goes inside.

the patio

Eddie was forty-one. Life had been a struggle, well, since he was discharged from the Navy some years ago. He hadn’t been looking after himself. He had PTSD, back pain. He smoked too much, didn’t take exercise. Didn’t drink alcohol, which was something, but abused his pain meds and went long periods without eating or drinking. Recently he’d become quite emaciated. Found it difficult to motivate himself in the morning. Spent long periods lying in bed, smoking, staring at the TV that was permanently on. Going through to the lounge became a major event. His family – particularly his elderly mother – did what they could. They were local, so that was handy. In fact, someone was able to look in on Eddie every day. Took it in turns to bring him cooked dinners, sausage casseroles and chicken pies in dishes covered in foil, which, despite their best efforts, went largely untouched. They turned up to take him to various appointments. Practically had to carry him out. His brother Chris decorated the flat. Even Eddie’s ex-wife popped round when she could. Everyone was worried. Things were getting worse, not better.

It was Eddie’s mum who found him. She’d come round to see that he’d got up that morning. He had a follow up appointment at the chest clinic and the way things were going he couldn’t afford to miss it. She was pleased to see his bed was empty. The bathroom door was shut so she guessed that’s where he was. She rapped on the door and said hello as she passed through to the kitchen to make a pot of tea. There was no reply, but he wasn’t chatty in the morning so she didn’t think too much of it. She clattered around getting the tea things ready, shouting out to Eddie about the appointment and this and that. She thought it was strange he didn’t say anything, though, not even a grunt. She stopped what she was doing and knocked on the door again. When he didn’t answer she pushed it open. It didn’t have a lock. You had to sing if you didn’t want company.

Eddie was collapsed on the toilet, a dreadful grey colour, slumped to the side across a low table, bottles of shampoo and conditioner, razors and cotton buds scattered around him.

She shook him by the shoulder, even slapped his face. Then phoned for Chris.

As soon as Chris saw his brother he knew he’d died. He dragged him off the toilet onto the floor, rang 999, and began pressing up and down on his chest, following instructions that the operator was giving him on the phone he had crooked between his ear and his shoulder.

When we arrived we knew it was hopeless, but Chris was doing CPR and the body was warm so we set to work. We dragged Eddie out of the bathroom into the hallway to give ourselves more room. A back-up crew arrived. Between us we did everything we could, but nothing changed. Eventually we had to take the decision to end the resus. We turned off the monitor and began tidying him up for the family. I went through to the bedroom to tell the mother and Chris that Eddie had died. The mother howled and tried to break past me, to do something, anything. But Chris hugged his arms round her, sat down with her on the bed, and let her sob the worst of it out. I said how sorry I was, and quietly left the room.

*

Later, I’m standing with Chris on the landing whilst the other paramedics finish ferrying the equipment out to the trucks. Chris has to go to the front door now and again to meet the next relative to arrive, telling them more than he could on the phone, preparing them as best he can, before showing them inside to where Eddie is lying in the hallway, a blanket over him up to his chin. Chris then takes them through to the bedroom where his mother is being comforted by the others who’ve arrived, then he comes back out onto the landing.

I’ve finished the paperwork. There’s nothing else to do but wait for the police to arrive. Every time I hear a car I glance out of the window, but mostly I devote my attention to Chris, who wants to talk about what’s happened, the past, the family, anything that comes to mind. He’s pale and tense but seems to be bearing up well. Chatting about his early retirement, the plans he’s made to give himself some space to think about the next move, that kind of thing. At one point there’s another terrible wail from inside the flat. He stiffens as if he’s about to go back in, but then takes a breath, folds his arms and leans back against the wall. He smiles, and shakes his head.

‘Well. At least it gets me out of steam-cleaning the patio,’ he says. But then he glances at me. ‘Sorry. That sounds terrible.’

‘Don’t worry. I know what you mean,’ I tell him.

And it’s true, I do.

acceptance

It looks like Pieter died in his sleep. He’s lying on his front on the floor with his face turned to the side, a duvet beneath him, a blanket on top. The window is open, warm air stirring the curtains. The radio is plays softly. I reach over and turn it off.

‘He often slept on the floor because of his back,’ says Abla, one of Pieter’s flatmates. ‘It was more comfortable for him.’

He stares down at his friend and then shakes his head sadly.

‘Ah, Pieter!’ he says. ‘You were like a brother to me.’

Then he turns and leads us back down the stairs.

The house has a warm and generous feel. Brightly painted walls crowded with photos, guitars propped up in corners, a piano in the sitting room, drapes and pictures and mementoes from a hundred gigs and parties. The long kitchen overlooks a patio garden with a miscellany of iron and wood chairs round a tatty wooden table. There’s a plump ginger cat draped on the far wall. A blackbird singing in an apple tree by the back door.

‘Can I make you some tea?’ says Abla.

‘Thanks. That’s kind.’

We take a seat at the kitchen table. Rae starts the paperwork. I call Control to request police to scene.

‘Nothing to worry about,’ she says. ‘It’s just what happens when there’s an unexpected death anywhere. They take over from us.’

‘I understand,’ says Abla. ‘Sugar?’

‘No thanks.’

He pauses for a moment by the cups, like he’s momentarily forgotten what it was he was supposed to be doing. But then he takes a breath and carries on.

‘I would not have believed this could happen,’ he says. ‘It is so unexpected. Pieter! Ah – man!’

He puts the cups in front of us, then joins us at the table, resting his chin on his hands and staring out of the open door at the apple tree.

‘A brother. He was like a brother to me,’ he says.

The house is something like a commune. Stefano, one of the other residents, is already busy on the phone to anyone he can reach, telling them the awful news.

‘Pieter works till late,’ says Stefano, between calls. ‘He came back in the early hours and went to bed. I heard the radio playing this morning but when I knocked and he didn’t answer I just thought he was sleeping. God! Why didn’t I go in?’

‘You must not worry about that,’ says Abla. ‘Why would you go in? This is so unexpected.’

‘But I might have made a difference?’

He turns back into the living room and blows his nose before making another call.

After a pause I talk to Abla about the house.

‘Yes. It is a wonderful, wonderful place,’ he says. ‘We have been together for many years. It is like a family. Some years ago we played in a band, and then we ended up staying here.’ He smiles and shrugs, gesturing with his hands. ‘Some people stay, some go, but it is always a big, happy place.’

The front door opens and Ken comes in, struggling sideways with two shopping bags.

‘What’s happened?’ he says, putting them down and looking at me and Rae with alarm.

‘Pieter has died,’ says Abla.

‘He’s died?’

‘Yes. I found him lying dead on the floor.’

‘Pieter?’

‘Yes.’

Ken looks at us again.

‘There’s no sign of anything,’ I tell him. ‘I’m really sorry.’

‘What did he die of, d’you think?’

‘It’s impossible to say. Was he complaining of feeling unwell lately?’

Ken puts one of the shopping bags on the counter and starts to unpack – sliced bread, milk, butter, tangerines.

‘Just his back. He said his back was playing up. But he’s been having trouble with his back for years.’

He turns to look at us with a jar of pickles in his hand.

‘Dead?’

‘I’m afraid so.’

He stands motionless for a second or two. Looks at Abla, who is shaking his head sadly.

‘I thought we could try these,’ he says, holding out the jar to him. ‘I thought they looked interesting.’

‘They do look good,’ says Abla.

‘Hmm,’ says Ken, puts them in a prominent place on the side, then carries on unpacking.

‘Wanda’s going to take this very hard,’ he says from over by the vegetable rack. ‘She’ll go crazy,’ he says.

‘How many people live here?’ I ask Abla.

‘At the moment we have ten. All nationalities. French, American, Tanzanian, Lincolnshire.’

‘Lincolnshire?’

‘That’s me,’ says Ken, filling the potato bin.

Behind him on the main window ledge is a line of glass Buddhas, half a dozen colours, radiant in the sunlight. Just in front of them is another, plastic version. This one must have a solar cell, because he’s busy nodding his head and waving a little fan that busily click-click-clicks against his rounded belly.

‘That one, he is busy saying yes to life, to anything that may happen,’ says Abla. ‘Whatever that may be.’

Stefano comes back into the kitchen.

‘Wanda’s on her way,’ he says.

the gist

Michael has fallen in the garden of his house. His neighbours saw the whole thing and called for an ambulance. Luckily it’s a fine day, because we have some distance to travel. Meanwhile, the neighbours fetch out whatever they can, half a dozen pillows, a duvet, one of those big, curved cushions to help with breast-feeding, so he’s pretty comfortable, all things considered.

At first I think that Michael must be a war veteran. He has a devastating facial wound, missing much of the right side of his upper jaw, the lips distorted around the hole. But the neighbours tell us it was actually cancer, twenty years ago, and how well he’s managed since.

It’s something of a miracle he can talk at all. That he can is more akin to ventriloquism than anything else. Without teeth, an upper palate and fully mobile lips, he has to produce the sounds deep in the well of his throat, like gargling air. It’s difficult to understand him, but I find that the more I relax and go for the gist, the easier it is.

He hasn’t hurt himself. We help him up; he weight bears, walks okay with a stroller. Says he doesn’t want to go to hospital.

The neighbours give their thanks and carry all their cushions and things back inside whilst we walk with Michael into his house.

It’s a bare, functional place, more like a hobbyist’s office than a residence. There’s a tiny sitting room with an upholstered chair, television and coffee table; a kitchenette with a blue Formica cupboard neatly stacked with tins and packets of cup-a-soup; a boxy bedroom with just enough space for a single bed, a single wardrobe, a single lamp, and a roll-top bath in the bathroom, whose drip stains could probably date the place as accurately as tree rings. Everything else, every wall-space and alcove, is given over to books – shelves and shelves of them, cricket almanacs and biographies, books about the war, old train timetables, stamp albums, Goon show scripts.

‘Good insulation’ I say.

He stops, swipes his hand in the air, then carries on shuffling forwards again.

We help him off with his coat and then sit him down in his chair. He spreads his fingers, running them over the worn curve of the armrests, resting his head back on the headrest and closing his eyes.

A moment or two later he opens them again.

‘Ud oo ah a ha o hee?’ he says

I look at him for a few seconds before I say:

‘That’d be great, Michael. Do you want one?’

help arrives

There are six people round the figure in the recovery position at the bus stop, arranged in height order, from the woman crouching at the head, the two kneeling along the back, one leaning over at the hips, and two standing guard at the feet. When I climb out of the response car, their faces turn together to point in my direction. It’s such a definite move it almost makes me stop in my tracks. All it needs is some Dutch master to paint the scene. And call it: Help Arrives.

‘I’m a doctor,’ says the young woman crouching at the head-end.

‘We’re pharmacists says the next, nodding to her right and left.

‘I’m an undercover police officer,’ says one of the serious-looking guys at the feet. He pulls out a police baseball cap and puts it on.

‘And so am I,’ says his colleague. If he has a cap, he leaves it off.

They all deliver the next lines, overlapping and anticipating each other. I listen to it all whilst I crouch beside the doctor, my hand at the patient’s wrist for want of anything else to do.

‘...we were passing when we saw him slide off the bench...’

‘...not an injurious fall...’

‘...he appeared to suffer a generalised seizure...’

‘...which lasted approximately two minutes...’

‘...good colour throughout...’

‘...perhaps a little congested...’

‘....definitely not cyanotic...’

‘...we guided him through that and then put him in the recovery position...’

‘... no signs of incontinence. We think the dampness is alcohol...’

‘...GCS no better than fourteen...’

‘....He’s known to the police. Usually wears one of those rugby-type caps. I’ve got his name and address when you’re ready...’

‘...He’s a user. I think the fits are alcohol related...’

‘...Perhaps you’d like to do a blood sugar...?

I get the kit out, and a bottle of oxygen and mask.

‘Could you put that on whilst I jab his finger?’

‘...allow me...’

‘I’ll call for a truck. He needs somewhere private to do more of an exam.’

‘...of course.’

‘Blood sugar five point four. So that’s good.’

‘That is good.’

‘Lovely.’

‘Okay.’

‘Great.’

They watch me as I radio for back-up.

‘Shouldn’t be long,’ I tell them.

‘...well you were pretty quick...’

‘Don’t get used to it!’ I say. They laugh. There’s a lull.

‘Well I must say - it’s pretty handy, having you lot on scene,’ I tell them, to make conversation if nothing else. ‘I’ll be okay here now if you need to get off.’

‘...we should really be going...’

‘...we’re at a health conference...’

‘...just down the road...’

‘...at the conference centre...’

The two police officers look more circumspect.

‘...ahm... we just happened to be passing....’

‘...we were.. ahm... on our way to work...’

I nod appreciatively. Give the patient another pinch. He moans, but he seems pretty stable.

I can hear sirens in the distance. A moment later, an ambulance negotiates the intersection and parks up behind my car.

‘Thanks for your help,’ I tell the group, looking from person to person. ‘You’ve been amazing.’

‘...glad to help...’

‘...business as usual, really...’

‘...a bit of excitement to get the juices flowing...’

‘...better than tea and biscuits...’

I turn to wave at the two paramedics strolling up onto the pavement in my direction; when I look back, I’m surprised to find that the good Samaritans have already dispersed, fluidly and anonymously, into the early morning crowd.

the oldest boozer in town

The Cross Keys is in a maze of alleyways so confusing I want to be running a ball of twine to find our way out again. It’s an ancient, tucked-away drinking hole, stone arched windows of gilded glass, a stone step smoothed flat as a pat of butter, the timbers low and black. Even I have to duck for the door beam, but once we’re inside the place opens out. The snugs and parlours and tap rooms have all been removed to create one big drinking hall, with a long, curving bar radiant with bottles and chrome and glass, and a brass pipe running along the bottom.

Jack is in one of the window seats with one of the bar staff standing next to him, a hand resting on his shoulder.

‘Jack’s one of our regulars,’ she says, giving him an encouraging squeeze. ‘He’s been coming in since forever.’

To be fair to Jack, the light through the window’s not all that flattering, giving everyone a slightly jaundiced complexion. But the glass isn’t responsible for the tideline of dirt on Jack’s scalp, his tattered, unwashed clothes, and a yeasty fug of neglect about him as rich as the golden patina of nicotine on his fingers.

‘In fact I think when Jack started coming in the landlord was still technically a pirate,’ she says.

Jack gives her a sorry little nod, but he’s not in the mood for banter. He’s stuck in the chair with pains in his right and left flank, no doubt a recurrence of the kidney infections he says he’s prone to. He says he doesn’t want pain relief. The girl tidies the table, putting his newspaper, glasses and huge mobile phone into a carrier bag whilst we help him into our carry chair.

She holds the doors.

We wheel him through.

‘That’s a shame,’ says someone outside, one of two passers-by who stand aside as we come out. I think he means us, carrying a man out of a pub, but as I wheel Jack away along the bumpy flags, I suppose there’s a chance he was actually commenting on the fact that the little boutique shop opposite had a sign in the window: Closing Down. Final Reductions.