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The Home Visit
The Home Visit

The Home Visit

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When I told Mrs Jennings, she had cancer I was struck by her response. She didn’t even cry. For a moment I was worried that she hadn’t heard me, or she’d misunderstood. But when, on further enquiry, I told her the prognosis was ‘poor’ she sat back and folded her hands.

‘I was going to stop smoking,’ she said. ‘But there’s no point now, is there?’

She was the last patient of my morning surgery. I was already running late, I always did. I put my stethoscope and blood pressure cuff into a tortured and torn Gladstone bag and checked my home visit allocation.

‘Daniel Arkazan – 74 year old, hallucinations and erratic behaviour.’

The name was new to me and other than being treated for a chest infection three years ago his records were empty. He’d never responded to any invitations for routine medicals. He’d never had blood tests or been admitted to hospital. Part of me had a respect for such types, ‘Avoid Doctors at all costs, that way madness lies.’ My Grandfathers mantra rang in my head. The longer I practiced, the less I disagreed with it. I looked again through his notes, but there was nothing.

The drive was short and unpleasant. Concrete all the way and one of the towns more decrepit tower blocks at the end of it. I got out of my car and looked upwards. For a moment I saw, or at least thought I saw a face, staring at me from the upper walkway. Small, perhaps a child’s but the light was poor. I looked again and it was gone. I was in no rush to reach my destination so took the stairs. Other than a baby crying the place was dead. I had to knock on twice before I heard movement. Finally, the door opened. A long, slim man regarded me. His face was drawn and he had deep set eyes beneath which hung black fleshy bags. There was no excess about him. His long brown arms were scarred and there were

bulbous veins at the wrist. The intensity of his gaze I found disconcerting. I smiled, he did not.

‘It’s the Doctor,’ I said.

‘Yes,’ he said. ‘You came before.’

‘No, I’ve never been here before.’

‘That was you,’ he insisted. ‘At the door. You knocked and then left.’

I fought the overpowering desire to walk away. It wasn’t that I felt threatened, more that the man’s presence, his very nature depressed me. He was confused, that was clear, but I wondered whether this had always been the case. He gestured for me to enter. I could feel him walking closely behind me. We passed down a poorly lit corridor into his living room. There was smoke and the smell of incense coming from a tall gold burner in the corner of the room. He sat cross legged on the thick Persian carpet.

‘Please sit.’

I perched on a three-legged rattan chair and placed my bag at my feet.

‘What may I do for you?’ I said.

He didn’t answer but fired a look at the door.

‘Did you hear that?’

‘Hear what?’

‘There’s someone outside.’

He stood and walked quickly to the door. He opened it to nothing. He returned and sat back down.

‘I’m sorry Doctor, he does this. It’s an invasion of the nerves. It’s making my purpose here increasingly difficult.’

‘And what is your purpose?’ I asked. Nothing about him or the room in which we sat provided clues to an occupation.

‘My purpose is functional. That is, to ensure the ongoing functionality of this unit – ‘tower block’ , if you will. Lifts, fire systems, thoroughfares. My purpose is to ensure that all the above are maintained. Although static in appearance, this place has many moving parts. It is my responsibility to ensure they continue to move smoothly.’

‘You live here alone?’

‘For thirty years I have lived alone. I was glad of this position at the outset, no longer do I feel so blessed.’

‘How do you feel?’

‘Encaged. As we all are. The trick is to make our cages as comfortable as possible. As a Doctor you must understand.’

The way he turned the conversation was disturbing. He had intelligence and was happy to manipulate words that were never there. It will be of no benefit to either of us to be drawn in, I told myself.

‘I came because people were concerned about you,’ I said.


‘Your neighbours. They’re worried about your behaviour.’

He smiled. ‘My neighbours have not been exposed to the same stresses as myself. Had they been, believe me, they would have lost their minds long ago.’

‘Can you elaborate?’

‘I once saw the remains of a woman who’d been burned to death. Have you ever seen such a thing Doctor?’

I ransacked my brain for some similar horror that I may have been exposed to at medical school, or perhaps on the wards in the early days as a junior doctor. But then I withdrew from such a line of thought, this would not help towards a diagnosis.

‘I have not.’

‘It was here, in this block. The walls looked like evil itself. Blackened, charred. Like peeling flesh from the hide of some monster. Of the woman, there was little to be seen. A shoe on the end of a stump of leg. The ferocity of the blaze turned her room into a furnace, that’s what they said. The door handles melted. She couldn’t escape. It happened here in this block, on the ground floor, sometime ago.’ He touched his temples with the tips of his fingers, I noticed he was sweating. He looked perpetually agitated, as though he might get up and leave at any moment. I had no idea what he might say or do next. I’d met people in a similar state of high anxiety before. I often wondered how they coped with the mental strain resultant of a perpetual bombardment of disturbing external (or internal) stimuli. I wondered how close his bearing on reality was.

‘I want to know what I can do for you. That’s why I’m here.’

He turned and stared at me, he looked like he might cry.

‘I want you to tell me I’m not mad.’

‘What makes you think you are?’ I asked.

‘The look on your face.’

He rocked back and forth, still watching me. It wasn’t a pleasant sight.

‘I’m concerned for you,’ this was true. ‘I wonder if you’re safe. You seem distracted. Do you feel unwell, feverous, nauseous?’

‘Ah, of course. You think my state of mind maybe secondary to some infection? These things must be excluded.’ he nodded. ‘I studied a little myself, in the medical school back home.’

There were thick blue books on the window ledge. Bookended by a large abacus.

‘But I wasted my time there. I chased women and drank. I left my family in disgrace. That was before the war, and now I’ here. I’ve been here ever since.’ He looked around the room, as if to suggest he’d never been beyond these four walls since leaving his family. I wondered which War he was referring to, possibly one of the numerous altercations in the middle East judging by his appearance. I was intrigued but decided against venturing further into this aspect of his history. I’d already spent more time with him than I had to spare. To me he looked to calmed since running to the door in response to a sound that I did not hear. However, there was still an edge to the man, an unsettled agitation biding its time on the periphery. To my eyes there was no evidence of organic illness, he did not look acutely unwell, more worn by his state of mind. I wondered whether there was any point in a physical examination, it was unlikely to get me any closer to the source of his anxiety which, in truth, was no mystery. Prolonged isolation combined with menial labour would play havoc with anyone’s nerves.

‘Do you have any friends or family?’

‘There was a lady. We’d meet in the park and walk. I’ve not seen her for some time. I think I may have upset her. She didn’t turn up one day, and I haven’t seen her since.’

‘How did you upset her?’ I asked.

I told her about…’ he thought for a second then changed tack. ‘She was like you?’

‘How so?’

‘She thought me mad.’

I was half glad the subject had resurfaced, it saved me a job.

‘You’ve been alone for some time. It’s too much for anyone. I wonder if it’s not had an effect on your nerves. Prolonged periods of solitude can turn the strongest of temperaments.’

The smile returned, as smiles go, it had not a single redeeming quality.

‘Would it help talking to someone?’ I asked.

‘Isn’t that we’re doing?’

‘A counsellor. Someone who might explore your concerns in more depth.’

He looked at me and for a second there was annoyance in his eyes.

‘You seem to forget Doctor. You’re here because of your concerns, not mine.’

The feeling returned. The lowness I’d felt the moment he’d opened the door. The sensation that I was in the presence of someone I could do little for. I think he knew that to be the case. I was being asked to join him on an excursion into something beyond my training. I’d had such invitations before, but the presence of the man exerted a singularly powerful force which took most of my resolve to resist. I wondered why he’d run to the door at a sound only he heard. I was keen not to visit the details of these events.

‘Did you hear that?’ The sheen of sweat almost instantaneously returned to his face. He looked like a man with a loaded gun to his head. Again, he ran to the door, this time I followed.

He opened the door and threw half his body over the edge of the walkway. He gesticulated furiously, firing his arm downwards like a water hammer.

‘There,’ he screamed. ‘You see him?’

I looked below but saw nothing. He saw this in me and immediately stopped. His eyes, though, were still wide, unblinking. Like some tormented animal seeking refuge from God knows what. He walked backwards, back from the gantry and over the threshold. Before I had time, he’d closed the door leaving me on the outside. I knocked.

‘Mr Arkazan.’ I spoke into the gap, the door not fully closed. I gently put my weight to it, it gave a little, I could feel him resisting.

‘I think,’ he said. ‘I have my answer.’

‘To what?’

‘On the question of my sanity. You think me mad.’

In my mind’s eye I pictured us both. Separated by an inch and a half of plywood, both listening for the slightest sound, monitoring any give, any variations or perturbations in the atmosphere. I wondered how I’d be drawn to this.

‘I can’t leave you like this,’ I said.

‘This is how I’ve always been.’

‘I wonder whether you might benefit for a time on hospital.’

He laughed and it was the worst sound I’d ever heard. A caustic, guttural sound, thick lines of phlegm vibrating within his larynx.

‘I think we both know I’m beyond such things.’

I pushed again. This time there was no give.

‘I’m very concerned for you.’ It was all I had left. I knew it was insufficient.

‘No Doctor, you’re concerned for yourself, we all are.’ I could hear him breathing, more slowly now. ‘We’re all in the business of saving our own skins, it’s just some are more honest about it than others. He won’t come again tonight, it’s too late. You’ll come and see me again Doctor. Don’t worry, I’ve no intentions of doing anything silly, not tonight.’

I’ve often wondered whether this is the right profession for me. Daily I compare myself to my colleagues who bounce into work with a lightness of step that is beyond anything I can muster. It is rare for me to leave my consulting room at the end of the day without some anxiety gnawing at my nervous system. What have I missed, wrongly diagnosed or poorly communicated? I do wake at night, more than I used to. The more I see, the less I can be sure of, as the outrageous complexity of my vocation becomes increasingly apparent. As a Doctor I am a gambler, playing the odds, assessing risk and probability. An infinity of variables. I’d be better off putting my life savings on red. The blackjack table is a kindergarten when compared to the consulting room. I’m on my limit and this recent visit, I knew, was the very thing which may push me beyond it.

I woke that night and pictured Mr Arkazan sitting alone, as he had done for years. Waiting, listening, like something feral. He had the face of a man that never slept, the face of a man beyond sleep, reddened sclera, paper thin temples. I wondered what life he’d had to end up there, in that hole, alone and afraid. I woke and summoned the strength to go to work.

The morning surgery was prolonged but uneventful. I was, perhaps, even slower than usual as the thought of seeing Mr Arkazan played on my mind. As I was about to leave the senior partner entered my consulting room. He put a hand on my shoulder, intimating me to sit. The door was ajar. He asked me how I was, that I appeared on edge, it had been noticed amongst my colleagues. He wanted to know whether there was anything on my mind, and whether it was having an impact on my work. We all have our moments, he told me. Then he closed the door and confided in me. He too, had been close to the edge for which he’d required time away and ‘help.’ There was no shame in it, which caused me to wonder why he spoke in such secretive tones.

‘You must protect yourself,’ he said.


‘The patients. They will consume you if you allow them. Remember you’re a Doctor, not a faith healer.’

I do not know whether he wanted to hear what I had to say, or perhaps, it was a warning, an indication that I was being watched. The ‘conversation’ lasted five minutes. It was the longest conversation I’d ever had with him in the ten years I’d been there. He left and I hadn’t said a word.

I had five visits allocated to me that day. More than that, Mr Denning the lady I’d delivered a diagnosis of cancer to the day before, had broken down and was demanding to talk with me. I bypassed it all to visit Mr Arkansan. Arriving at the tower block I walked the gantry to his front door. I felt like a condemned man crossing the bridge of sighs. The door was already open, he was waiting for me. He sat cross legged head in hands. The initial sensation was one of relief, at least he was alive, but when he looked at me, I realised that this was barely the case.

‘I was visited again last night.’

I sat on the floor, cross legged, like him. Perhaps my proximity would provide some relief.

‘A child. No more than seven years of age. I saw him again.’

I realised that the subject needed to be broached for any possibility of salvation.

‘Would you like to talk about him?’

‘There’s something you need to understand Doctor. These visitations, they always prefigure some event, some horror. The child I saw last night, I’ve seen him before on two occasions after which there always, always follows some catastrophe.’

He hadn’t looked at me once. His thin fingers tapping out some manic rhythm upon his temples. I tried to put a hand to his shoulder, but it was pushed away.

‘The woman that burned to death, you remember me telling you about her,’ he made eye contact, I felt I was being measured.


‘That happened here, on the ground floor of this block. That’s when I last saw the child, the night the fire started. He always presents himself in the same fashion. I hear a ferocious thud at the door -.’

‘Are you sure it’s not some misbehaving youngster that should be in bed, banging at your door and running?’

‘No, I wished that it were. The sound that announces his arrival is not that of someone banging at the door, it is much much worse.’ His nervous agitation was manifested by rapid movements of his head. He drew breath and continued. ‘The sound I hear is that of flesh being smashed, bones splintering. A child is not capable of making such a vile commotion.’

‘And then?’

He spoke more slowly now, as if reliving the event. ‘I run to the door, I open the door, I look over the railing and the child is there. His eyes are wide, he’s stretching both his arms forward, fingers splayed and he’s screaming ‘Hey, up there. Stop!’ It’s as if I’m threatening him.’

This time he allowed me to place my hand on his shoulder. The pulsations of his heart were transmitted to my arm such was the force and rapidity of the ejections. I wondered whether diazepam might help.

‘It’s always the same. The child is a sign, a presentiment, a vision that tells me I am on the verge of some horror,’ he was speaking quickly now. ‘Some time ago I found a man, or at least the remains of a man. Alone in his flat. Dead. He been dead so long he was inseparable from the armchair in which he died. It was the smell that alerted me to him. Decay and putrefaction. I had to break the door down such was the mountain of mail. Other than a chair and a television set the room was bare. His corpse stared at me, though his eyes had rotted in their sockets. I found him at night.’

‘But what relevance is the child?’

‘At the inquest they said he’d died six months before being found. That’s when I’d seen the child. He died on the night I’d seen the child. Don’t you see the vision always has meaning, always. And the vision never deviates, the thunderous crash, the boy standing at foot of the tower. Hooded, hands aloft. ‘Hey, up there!’ He screams, ‘stop, stop!’ Last night I saw his face for the first time.’

‘And what did you see?’ The question was an admittance that I’d entered his world. I lied to myself that this may help, benefit his progress. To play along, to humour. There was, as far as I could tell, no alternative. He was dealing in the realms of spirits and mysticism, a realm I’d never, before, had time for. The longer I spent in that room, with him, the harder I found it to anchor myself to those lifelong reference points. As a diver in the deep blue becomes disorientated, no longer able to differentiate up from down, so to, I was no longer capable of sorting truth from make believe. Did the child exist? Had these tragedies occurred? Was Arkazan a visionary or psychotic? I had a basic understanding of the means by which a personality might split in order to survive, this was the first time I’d ever borne witness to it.

‘You saw the child’s face,’ I repeated. ‘Can you describe it?’

‘Death,’ said Arkazan. ‘His face is death. He moves, he speaks but the child is death. Like some animated corpse. There was a power about it, oh such power. It was immortal, I would say ‘he’ but it wasn’t the face of a child that I saw. I didn’t want to, but I had to, I had to see the child’s face. It made me feel…’

Mr Arkasan rubbed his arm and looked at me. He was searching for permission to go on. Examining me for any trace of derision. There was none. It’d been better had there were, but I was hooked. I knew I’d be there at the end, I just had no idea what that may be.

‘How did it make you feel?’ I asked.

‘As though I were in Hell.’

I’ve been accused of weakness in the past. The senior partner would often make sly reference to the length of my consultations, the amount of time and effort I’d expend in my attempts to make my patient’s sorry lives less so. ‘Some problems don’t have solutions.’ The message was delivered in a Fatherly manner but there was steel behind the velvet tone. And now, I’d gone too far into the hinterland on the trail of Mr Arkazan. As I mentally retraced my steps, even now I’m unable to identify a point of escape. I do wonder what others would have done. Time was running out, there were other visits to be made. And then return to the surgery. Back to that other battle ground, to fend off, procure and humour where possible, all the while being worked on by that inbuilt self-doubt honed from youth.

‘I’m very concerned for you.’

Arkazan’s head spun on his neck. He looked at me, as if, for the first time.

‘This has gone on too long. I worry that you may come to harm.’

He smiled, he looked rabid. ‘Don’t you see,’ he said. ‘I’m getting closer. The child, I’m getting closer to the child. It’s just a matter of possession. Once I have that, then this will be over.’

‘I don’t understand.’

‘You will,’ he said. ‘Come tomorrow, then you’ll see.’

I stood at the door holding my bag. I looked back at him, barely moving, in the corner. For a moment I pondered on giving him something for his nerves, but he appeared calmer than me now, besides, the tone he adopted denied any offers of help, that much I knew. I’ve no idea how long I stood, looking at him. Never have I left a patient in such a state. But what to do? The Police, for him to be taken – against his will. The impossibility of convincing someone that his life was on the brink was not lost on me.

‘I’ll come tomorrow,’ I said.

‘I know.’

The rest of that day is blank to me. I know I completed my remaining allocation of visits. Including that of poor Mrs Denning, but what took place there I’ve no idea. I think I performed adequately, that is, the patients I attended to seemed happy with the attention I gave them. But and I can admit this now, it was a performance on my own part. I have no recollection of what was said or what actions I took such was my obsession with Mr Arkazan. I remember years before, as a student of medicine being taught the manifestations of a heart attack. Some heavily bearded Physician reciting the symptoms a patient may experience as the heart muscle begins to die. Chest pain, of course, shortness of breath, possibly, palpitations, vomiting, a sense of impending doom. It is the latter that stuck with me, and now, hung around me like a heavy damp cloak. A sense of impending doom. As the cardiac tissue is deprived of oxygen it infarcts, as was the fabric of my own reason. I had lost all perspective. If it had been possible, I would have stayed with him that night. But then, and I almost chuckle when I think of this, I’d have been the one requiring the attentions of a psychiatrist. As I left my consulting room that evening, I saw the senior partner. I felt him watch me as I closed and locked the door.

‘How is our Mr Arkazan?’ he asked.

I wasn’t ready for it, that he knew. To tell him all? ‘He’s clinically insane but denying all offers of help. I think I maybe going the same way.’ I quickly played the revelation out in my head. Was he being my friend, or looking to expose my weakness? He’d never demonstrated concern in the past, why now?

‘You’ve visited him twice in the past two days. Can he not come here?’

The idea that my every movement was known to the senior partner brought sweat to my back. For a decade my working day had been an exercise in isolation. My only company being the sick, work-shy and anxious. The senior partner had, for all this time been, on the other side of a thin wall, rarely breaking cover but always maintaining a sharp eye on every occurrence within his fiefdom. And, if I was to broach my concerns regards Mr Arkazan, the chances of a quick derisive dismissal were great.

‘Agoraphobia,’ I said. ‘He’s delicate, but I’m getting there.’

I don’t know why I bothered lying in my bed that night. When sleep did visit me the slate grey early morning light seeped through the ineffectual defences at my window. I didn’t shower. I didn’t eat. I dressed and drove straight to Mr Arkazan. Despite the hour there was activity there. A small gathering at the foot of the tower block. Heads bowed, encircling something or someone on the floor. I got out of the car before it stopped, left the keys in the ignition and approached. Without a word I pulled shoulders apart such was my desire to discover that which had been hidden. In truth, I already knew what they were staring at. The body of Mr Arkazan, prostrate and cold. The side of his face pressed into the paving stones, as if listening to the bowels of the earth. Congealed blood gluing his split forehead to the cement.

‘I saw him. I could see he was gonna do it. He looked over the edge, he was looking straight at me.’

‘What did you do?’

A young boy was being interrogated by an older man.

‘I put my hands up, like this,’ the boy raised his arms and splayed his fingers.

‘Didn’t you call to him?’

‘I did. ‘Hey, up there, stop, stop!’ I screamed it. He could see me. He still went over.’

The boy was hooded, I couldn’t see his face, nor did I wish to.

I told them all I knew at the Coroners enquiry. Mr Arkazan’s sightings of the boy, his increased agitation, the prolonged isolation. I even told them that Mr Arkazan’s fall had been witnessed by a child whose actions he’d foreseen. The Coroner listened attentively, or so I thought.

‘As clear a case psychosis as one is ever likely to see,’ he concluded.

Afterwards I was taken to one side by the senior partner. ‘These things come with the territory,’ he said. ‘You shouldn’t get too upset by it.’

‘I’m not,’ I replied. ‘That’s what terrifies me.’

I left a day later.

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14 Aug, 2019
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