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Chapter 4 Part One THE HEALTH PROFESSIONAL
Marcy. She liked the sound of that. Marcy, Darcy, Clancy, Casey, Marcy, sounds a bit American - a private detective, an A&E doctor from an Amazon Prime TV series, The Deputy Chief of the CIA or The Head of Security in The Whitehouse (it’s the ‘y’ that does it). MarcY. Marcia - a bit too Hackney soulful, can’t have that. Marcy Dunton (Health Professional) - that’s better, Marcy defo.
Marcia, Marcy, had skills. You could see that. The certificates said so: certificates going as far back as her 2nd year in primary school when she gained her level 8 swimmers medal for 25 metres of breaststroke. That was her first one. Since then, thirty-seven years on, she had received many, her favourites being her NVQs (National Vocational Qualifications) in various areas of Health and Social Care and Prison Services, which included her 4222 (grade P), 4345 (level 3), 4200-32 (level 3) and, the creme de la creme, her PRA qualification No 9200 - 45A - a passport to the top of any pile of Curriculum Vitaes in the Human Resources Department of a Local Government Office or ATOS or any other place of employment that required the meticulous shuffling of bits of paper. There were various others which she couldn’t tell you the number or grade, or precisely what use they were to anyone, but as they were framed and hung on the walls of her office, it would be easy enough to reacquaint herself with them.
For Marcy, getting out of the office required a lot of planning and preparation, the most important being the painting of her toenails - an absolute necessity for those with a penchant for a medium heeled open toe shoe. Marcy had always liked the peep-toe styles and had deemed it her greatest failure in life to have developed a fungal infection under the nails of her two largest pale pink pedial extremities (big toes) that even the most expensive medication money could buy had refused to eradicate. But over the years, with the careful scraping of a sheet of .001 glass paper and a few extra coats of nail varnish, she had learned how to disguise it - yet another skill to add to her long list of achievements. Vanity aside, the importance of appearance when out in the field, according to the NVQ 3647/B subsection 1c of Communication Skills, subsection: Maintaining Authority, was/is paramount, language coming a distant third to physical gesturing. In the Prison Service, it was much easier. The chain of office, the mark of ascendancy, hung off the shoulders in the form of a uniform. It separated the kept from the keepers. The blues declared, the orange pyjama jumpsuits jumped and if they didn’t they would pay. To be fair to Marcy, she always went by the book, no eighth of an ounce of snout Baron bribing for a hand scalding or a quarter for disfigurement and hospitalization, no not Marcy. She did the paperwork: solitary confinement, loss of remission, suspension of privileges - by the book. Well almost. But let’s face it, everyone has their little weaknesses. A perk is a perk after all. It’s what keeps the cogs greased, the wheels churning. A discrete wink or secret handshake from those who ranked above her would confirm that unwritten entitlement. So, back to back in the field, the world without a wall around it. That requires a more discrete, one might say, subtle approach: conversation, persuasion, tact, and if that failed, there were always threats and intimidation.
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The journey from the office in Islington Park Street to Woodford on the border of Essex takes, on a good day, 45 minutes by car. Some might have complained that the circumference of their jurisdiction was too wide but for Marcy, it was an indication of the trust the Department had in her. Besides, Marcy liked driving: the sense of freedom, the wind in her hair, the 800-watt car stereo, turned up to eleven, blasting out monotonal bass lines while the touch-sensitive power steering of her Mercedes SUV 27 reg adheres to every command transmitted through her unsynchronised tapping fingers.
The car slows down as it approaches the Wanstead exit of the A12. From here on, the drive through the village-like, leafy outer boroughs is frustratingly slow, but having factored in a ten-minute contingency, she arrives at her destination with enough time to check her face and hair in the mirror and smooth out the creases of her blue Matron style top. The dark blue top with white piping, reminiscent of one worn by those who have spent half a lifetime gaining the skills for the authority to wear it, is, of course, a well-calculated device - an object to help create a suitable professional distance between herself and the minions she reigns over, like Joan, for instance, the Aunty of the children’s home, the head carer.
Having heard the racket and incensed that anyone should be thoughtless enough to play music so loud in the grounds of an establishment of care, Joan goes outside. On recognising the shock of bright red hair topping the blue and white uniform with the incongruous enhancement of Prada trousers and green, soft leather open-toe shoes, her confrontation ready stance immediately shrinks to no less than a metaphysical curtsey. With a strained smile, the one she had been rehearsing all morning, she greets Marcy and invites her in.
Churchill House is home to twelve children, eight of which are down syndrome now referred to, by those up to date with the latest edition of the Encyclopedia of New Council Speak, as Subs. Jonathan is one of them. Yesterday it was his seventeenth birthday. Yesterday he was blowing out candles and stuffing himself with cake. Today it’s his assessment.
Marcy would have preferred to be on her own with the Churchill House clients. Joan was always distracting, chipping in with her unwanted opinions, slowing down the process with her pathetic sentimentality. If Marcy had her way she would have been gone a long time ago. But the maths were in her favour. The points awarded for her excellence in keeping an orderly, well-behaved house (‘Happy’ not having a tick box) marginally outweighed those against for her inability to engage fully with the pragmatism of the system. You can’t argue with the maths. A point that Marcia accepted, but, in this instance, begrudgingly so.
Just by looking at the photograph and reading the notes in the file, Marcia could tell Jonathan was a prime case for NVD (Non-Voluntary Departure) however, ticking that box at the bottom of the form without the reinforcement from the boxes above it would go against the impartiality of the process. As mentioned before, the Maths are sacrosanct, her opinion of no consequence - a fallacy she relishes in presenting as gospel when conclusions are challenged.
Refusing the offer of a cup of tea, preferring to get right down to business, Marcia sits in the office while Joan goes to find Jonathan. He is in the garden, his favourite place, transferring potted pansies into one of the many hip level troughs of earth specially built for him. His physical limitations had prevented Jonathan from taking part in this activity until the resident handyman had come up with the idea of a disability-friendly garden. After years and months of careful tendering, the beds are an array of colour and fragrance equal to any a seasoned horticulturist could create. Here, like the plants, Jonathan had also blossomed - transformed from a brutalised, abandoned child into a confident outgoing young man brimming with energy and affection for all, deserving or not.
‘Toilet?’
‘?’ Joan is not sure what Marcy means.
‘Can he use the toilet on his own? Does he need help?’ reiterates Marcy with a condescending smile as an afterthought to her noticeable irritation.
‘Yes although he needs a higher seat. Standard size ones are a bit low for him. But he manages very well.’
Marcia writes ‘needs help with toilet’. The pen continues its horizontal trajectory across the page. Its scribbling motion would suggest more considered detail, although, in reality, no other words are written.
‘Washing himself?’
‘He needs help to get into a bath but no problems with the shower. It’s a walk-in shower and there’s a perching stool in there if he needs to sit down. He’s very clean.’
‘Mmmmm…..’ Marcy looks at Jonathan’s hands. They are grubby from replanting the pansies, his fingernails black with earth and peat. ‘Needs help washing - unkempt.’ She writes.
Jonathan, who up to now has said nothing, asks Marcy if she would like to see his garden. Joan explains that it’s his favourite activity and that she is sure he would be a great asset to a garden centre. ‘You would love that wouldn’t you Jonathan.’ Says Joan, prompting him to show his enthusiasm for his self-motivated labour. Jonathan responds with excited animated chatter while Marcy writes as though she is taking dictation, as though this was useful information that would be considered in her appraisal, knowing all along that the only work her department could offer someone with learning difficulties would be in a live-in warehouse packing boxes and stacking shelves or working on the land picking crops. Jonathan’s additional physical limitations would, of course, disqualify him from all such possibilities.
Marcy goes through the rest of the form adding the odd comment here and there and ticking the score boxes: shopping, making meals, eating, communication, hearing, eyesight, dressing, undressing, using public transport, literacy, computer literacy, mobility, mobility, mobility. Although ‘high functioning’ in many areas, Jonathan’s mobility issues are against him. They affect most of the other categories and, consequently, the mark, as Marcy had predicted, is low. The assessment form has fourteen sets of ten tick boxes. The score of 140 would guarantee the candidate a trial for the UK Olympic team, 80 - 100 the extremely rare possibility of an independent life outside the institutions, 50 - 79 work in the live-in warehouses and 01 - 49 a two week holiday in a Linslaine respite centre. Jonathan has scored 25 points. The notes in the ‘additional information’ boxes, however, are not wasted and will be passed on to the transportation team. A reprise of a few months would be possible depending on Jonathan’s medical records, particularly his latest tests - Kidney, Pancreas, Liver, Heart, Lung, Intestine, Cornea, Middle ear, Skin, Bone, Bone marrow, Heart valves, Connective tissue. According to the results, the Kidneys, Pancreas and Liver are functioning well - P, P, P (Possible) - the rest are O.F.L. (Organ Function Limited) or, as referred to in Council Speak inter-office communications, ‘Offal’.
Marcia hand collates the paperwork, taps the sheets on her knee and puts them away in her briefcase. Joan is keen to know what might happen to Jonathan but Marcia is not at liberty to say. As in all cases, the information needs careful consideration and they will be informed in the near future……………………
The music blasts out of the speakers as Marcy turns on the engine of her S U V. Jonathan, who is standing by the door waving goodbye to his new friend, clasps his hands over his ears. Joan ushers him back inside and waits there until the car is out of sight.
Five hundred and twenty thousand pounds, not including medical bills, is what it had cost the state (according to the state) to look after Jonathan for the ten years he had lived at Churchill House. Marcia takes a moment to do the mental arithmetic, a skill she prides herself on - a distraction from the monotony when stuck in heavy traffic. She notes - even if Jonathan were to be, by some miraculous intervention, able to work in the warehouses, he would make £7.00 per hour, 14 hours a day, 6 days a week. That’s £588 less £480 for his keep - clothing, food and shelter - equals £108 per week. £520,000 divided by 108 equals 4,814 weeks. Even without medical bills, time deducted for toilet breaks and days off, it would take Jonathan nearly 93 years to pay what he owes. The average lifespan of a person with Down Syndrome is 60, so Jonathan would have a working life of 43 years earning £241,488. £520,000 minus £241,488 equals £278,512, over a quarter of a million pounds deficit. Without work, Jonathan would cost the taxpayer £2,756,000 and, as Jason Reich Mosley rightly says - ‘We simply can’t afford it. After all, life is not a Human Right it is a privilege one must earn.’
Whatever was holding up the traffic has now cleared. Marcia shifts gear and moves into the fast lane. The fast lane is where she sees herself - the fast lane of life, the sense of freedom, the wind in her hair, the 800-watt car stereo, turned up to eleven, blasting out monotonal bass lines while the touch-sensitive power steering of her Mercedes SUV 27 reg adheres to every command transmitted through her unsynchronised tapping fingers. Today is not yet over and she has already racked up two and a quarter million pounds of taxpayer savings. Just in one morning, she has earned the right to be. Marcy, trying to think of a witty metaphor for Joan who is in the slow lane and will eventually, with her sentimentality and inability to grasp the mathematics of the new order, run out of petrol leaving herself to the mercy of those who are in the fast lane and haven’t run out of petrol because their tanks are brimming…………..with petrol, swerves left, cutting up the driver behind her, and exits the motorway.
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The Millennial Care Home in Tower Hamlets is now licenced by the local authority. For years its existence was hanging by a thread having a record of ‘significant failings’ - bullying, neglect, abuse and suspected trafficking of minors. Now, thanks to the diligence of Marcia Dunton and her team, and the London Child Safeguarding Board having been (conveniently - to some) decommissioned, the home for children is now a well run, clean, safe environment for the fifteen teenagers that are housed there. At least that’s what the report says. Marcy is visiting the home later, but first, she has to meet someone.
A young man, late teens, is standing outside Mile End tube station. Dressed in a fashionable expensive suit, he looks much older than his nineteen years. Marcy has been watching him for a good five minutes. She’s not happy. Mark has lived at Millennial Care since he was fifteen years old. He was small then, five foot four. Over the last four years, he has matured much quicker than Marcy would have preferred and is now a tall, athletic-looking young adult. ‘Adult’ is a magic word, a bad magic word. How much longer would she be able to keep him in the home? Technically he should have left two years ago. The armed forces would have snapped him up with a referral of recommendation from the Department, but Mark was just too useful to let go, at least until she can find a replacement.
Marcy paps the horn and waves her hand through the side window. A couple of impatient honks later, Mark is weaving his way through the standing traffic and manages to get to the opposite side of the road before the lights change. The bright morning has turned into a grey afternoon. Misty, said the forecast, and they weren’t wrong. The door swings open. Mark jumps into the passenger seat bringing the cold, damp air with him. The S U V swerves its way into the stream of traffic and carries on down the Mile End Road.
‘What’s his name.’
‘Hi Mark how’re you doin’. Nice to see you.’ Says Mark sarcastically. ‘His name is Dillon.’
‘Don’t you get smart with me young man.’ She says, half-jokingly. ‘And what have I told you about wearing suits. Looks too expensive. Makes you look older. You know the score. Don’t smile, I’m serious. Anyway, how old is this Dillon?’
‘Fifteen but he looks younger. Could pass for twelve. He’s perfect.’
‘Did you sort him out?’
‘Yup. Got the other kids to pick on him. He was shit scared. Then I stepped in and told them to back off. Now I’m protecting him. I’m his best mate. He’ll do whatever I say.’
‘Is he up for it? Does he ……...’
‘Bit shy at first, but you know ………. a bit of weed, a glass of vodka - well up for it. By the way, you owe me for a new pair of trainers. He’s very pleased with em.’
‘I’m going there now. I’ll check him out. I need you with me later but I don’t want fucking Arfur and Marfur seeing us together so get out here and be there in ten.’
Marcy pulls over and drops Marc off a couple of minutes walk away from the Millenial Home.
‘And lose the fucking suite. It’s too obvious. Tracksuit and trainers. You get me?’
Don and Barry (Arfur and Marfur) were not expecting Marcy. Marcy turned up at Millenial House whenever she wanted to and never thought it necessary to phone ahead to tell them she was coming. Not that Don and Barry could have done much to prepare for a visit in terms of making the place look more presentable. Due to budget restraints, the damp, peeling paintwork and the various health and safety violations were problems that had persisted since Marcy’s department had taken over the responsibility for the day to day running of the home. Don and Barry’s regular complaints were only halted by a gentle reminder that Barry’s father (Don’s father in law) was only one backhanded little brown envelope away from losing his place in the care home for the elderly.
The smell of stale oven chips and the faint whiff of skunkweed greets Marcy as she enters Millennial House. Quiet sets the mood of a place housing fifteen teenagers. A forty-something, jeans and check flannel shirted Don is standing on a ladder with a screwdriver in his hand trying to fix a hanging smoke alarm back onto the ceiling. His head and shoulders are covered with a white powder from the falling plaster that is just too old and damp to hold a rawl plug. A few seconds of breath level expletives follow before he notices Marcy standing in the hallway. He’s trying to look like he is pleased to see her, but, still preoccupied, his attempt at a warm greeting is far from convincing. Barry, on hearing the name of the last person on earth he wants to see, marches out of the kitchen wiping his hands on a tea towel.
‘We weren’t expecting you.’ Says Barry, stating the obvious.
Marcy scans the floor and ceiling.
‘I can see that.’ she replies with her usual hint of sarcasm that somehow makes the couple feel guilty and responsible for the dilapidated state of the place. ‘I just thought I would pop in, see how the newbies are doing.’
The new residents she is referring to moved in a month ago - two teenage girls and one boy, she thinks, but, not having bothered to check their names on the files, she’s not sure. Making no apology for not phoning or visiting earlier to see that they had arrived safely and settled, Marcy, uninvited, makes her way down to the office at the bottom of the corridor. Don and Barry follow, almost bumping into her as she stops abruptly to make a mental note of the missing carpet tile.
Marcy, now sitting on the only chair in the dowdy office, flicks through three files as Don and Barry stand in attendance waiting for further instruction.
‘Can I see Dillon? I notice that there’s a slight discrepancy in his medical notes. We don’t seem to have the same information.’
Not questioning how she could have noticed that with less than a minute’s scrutiny of the thick pile of paper, Don goes off to find him. Marcy, keen to present herself to the newbie in her full capacity as a health professional, removes her overcoat revealing her matron’s top.
Mark was right, Dillon could easily pass for a twelve-year-old, eleven at a push: small, blue-eyed innocence shining from beneath his untamed light brown fringe.
Marcy dismisses Don and Barry with a knowing nod of the head in the direction of the door. They can hear her out-of-character good-humoured chatter as they walk down the corridor. Barry, uneasy at leaving Dillon on his own with ‘her’ stops abruptly and turns to go back. Don grabs his shoulder, swings him around and, with a silent waving of the finger, reminds him of what is at stake should they interfere.
Back in the office, Marcy is pressing a stethoscope against Dillon’s shirtless back. With the authority of someone who knows what they are doing, she taps her finger on his rib cage. ‘All good.’ She says, as though she would know if it wasn’t. The check-up continues with inspection of ears, nose and throat, all of which, according to Marcy, are ‘all good’. The next stage is trickier. Dillon feels uncomfortable about removing his trousers, but with Marcy’s gentle reassurance that he has nothing she hasn’t seen before, he reluctantly takes them off. This part of the examination, the part that all schoolboys dread the most, lasts embarrassingly longer than might be expected. Finally, after getting the involuntary reaction she was hoping for, Marcy is convinced - Dillon is perfect.
Perfection calls for a celebration. The diet that would shed those extra pounds that had accumulated around Marcy’s midriff over the years would have to be put on hold for yet another day. The starter of Pancetta-wrapped pork meatballs, the extra cheese topping and the bottle of Prosecco, Pizza Express’ finest, were just too good to miss, let alone the Millionaire’s Fudge Cake. Celebration accompanies education. She would leave most of that to Mark. He knows the ropes: the private parties, the quick dates in the back seat of a limo, the weekends spent in the discrete second homes of those with too much authority to have their inappropriate inclinations questioned. Mark knew the ropes alright - ‘A smart cookie that one.’ Marcy could see that the first time she met him when they brought him in. How he had managed to survive on his own for the three years after his grandmother had died was nobody’s business, but he was well-nourished, well dressed, too well dressed, and self-educated. He would have been off like a shot, back in the dark world of street existence, hadn’t Marcy recognised his talents and shown him how they could be put to better use that would profit both of them.
Three empty pizza plates are waiting to be taken away. Marcy’s bottle of Prosecco is almost finished, the fizzy liquid now noisily churning its way through the half-digested pork pancetta and sourdough American Hot with extra chillies. Mark is showing Dillon the dessert menu. Baked vanilla cheesecake seems to be the favourite with an extra blob of ice cream - a far cry from the Millennial’s staple of burgers, beans and oven chips. Now they are laughing. Mark is teasing Dillon - something about eating his own body weight in dough balls and still having room for a double pudding. Marcy watches in awe, in awe of the skills that can take a shy, nervous young man and make him make feel special, feel like he has a future, feel like he belongs to a team, has found a new family that will take care of him. ‘Mark is a smart cookie alright, that’s for sure, a little too smart maybe?’
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The telephone rings. She’s annoyed. Marcy had told the receptionist to say she was in a meeting, all day, and not to put any calls through, but on hearing the name of the caller, her tone changes - softens into her charming telephone voice, a quick rehearsal in correct pronunciation before the performance -
‘Put him through would you Audrey.’
It’s Doctor Baker. The fact that he has called so soon would suggest the matter is urgent and if the matter is what she thinks it might be, she would prefer to call him back on a mobile. ‘Your call may be recorded for quality and training purposes’ was never likely to happen, but, then again, you never know. Marcy fiddles in her briefcase. She pulls out a cheap mobile still in its wrapping. Taking care not to prize off her brand new nail extensions, she releases it from the tight confines of the plastic and cardboard and punches in the numbers.
The conversation that follows contains many words that Marcy doesn’t understand - computed tomography, electrocardiogram negative cross-match, matching antigens, Rh factor, ABO compatibility and many more - but she is flattered that Doctor Baker thinks she does and happy to be talking with a fellow health professional. All she really needs to know is the time and place and all he really needs to know is how much - cash or transfer. The required paperwork has already been prepared, records altered accordingly, confirmed and signed by those above who will receive their share of the transaction once the procedure is complete.
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Jonathan had enjoyed his visit to Harley Street or rather he had enjoyed the drive into Central London. The unpleasantness of the poking, prodding and scans were soon forgotten after a visit to Madame Tussauds and a belly full of Burger King’s finest. With memories of a pleasant day still vivid, Marcy’s arrival at Churchill House is met with excitement in anticipation of another day out with his new friend - a drive into the countryside, a walk in a maze, seeing the horses, tea and scones in the big house.
Marcy is relieved to see the exit of the Northbound M11. For the last forty-five minutes, Jonathan’s enthusiasm has not waned in the slightest, marvelling at even the most mundane sites that others wouldn’t think worthy of a comment. Seeing the big house at the bottom of the leafy country lane elevates his excitement even further, and it’s not until they reach the wrought-iron gates of the main ground’s entrance that he calms down into silence, his attention now taken by the four armed ISS guards, hands raised in halt position as they approach them. Marcy is prepared. She has her ID and relevant documents ready and waiting on the dashboard. Despite this, they are both asked to step out of the vehicle and wait until it is searched and electronically swept for any devices containing explosives (presumably). The check is interrupted by the sound of rubber skidding on gravel. Two more cars have arrived in a hurry - custom-built Jaguar XJ Sentinel supercharged 5.0 litre V something or other, notes Marcy - identical in every way apart from the one at the rear has blacked-out windows and no number plates. The gates are opened immediately and, without being checked, they are waved on through the gauntlet of saluting guards standing to attention.
Marcy and Jonathan get back in the car but are not allowed to go until the Jaguars have reached the house. Through the haze of the fountain, Marcy can just about make out the figure of a grey-suited late middle-aged man being escorted into the building while the other two members of the entourage take up position by the door, one pressing a finger on his earpiece and talking into his palm while the other stands with his hand placed against his chest inside his jacket.
‘Guns. They’ve got guns. Are they real ones?’ says Jonathan, straining his neck to look back at the strange men closing the gate behind them.
Marcy doesn’t need to answer. Jonathan has just noticed the horses in the coral at the end of the field. He wants to get out and have a closer look but Marcy tries to explain that they have to check in first.
‘There’ll be plenty of time for that later.’
Dr Baker, a silver-haired gentleman, at least three sizes too big for his suit trousers, but nonetheless comfortable with his podgy stature, is waiting for them by the reception desk. The English Baroque style of the eighteenth century is Doctor Baker’s passion, so being here has put him in a good mood - a home from home, as he likes to say. Linslaine House, private hospital and care home for those rich enough to be able to afford the six-figure annual fee, is a fine example of his passion and he never misses an opportunity to point out, in great detail, the replaced features that he had advised on when the building was being restored. Marcy had heard it all before, many times, and would have preferred to get down to business and leave. Jonathan would have preferred to look at the garden and see the horses but is happy to listen, happy with the attention Dr Baker is giving him.
‘Well young man, I hope you are going to enjoy your stay with us,’ marks the end of the lecture and, to Marcy’s relief, they are finally getting down to business.
‘The Minist……..,’ Dr Baker corrects himself. ‘The client arrived just before you came. ‘Professor Hadd……’ Dr Baker corrects himself again, ‘The consultant has been through the notes and Jonathan’s results and thinks that the outcome should be positive. As you know, Jonathan needs to be with us for five days and then you can come and get him. If anything goes wrong, not that it should, I’ll be in touch, but otherwise, as we said, you can pick him up on the Tuesday morning.’
The conversation continues quietly, not that Jonathan would have understood - ‘the absolute need for discretion,’ the reaffirmed ‘guarantee that anything seen or heard should be forgotten and that no records, paper or digital, would lead back to …….. .’ The conversation was unnecessary. Marcy would take care of that. She had already made the arrangements.
Two male nurses enter the reception area. They have a wheelchair. Jonathan seems a little confused about why he should have to go with them. He turns his head to look back at Marcy and the Doctor, says something about horses and walking in the garden.
‘There’ll be plenty of time for that later.’
To be continued……………………..