She flapped a hand dismissively, all varnished nails and chunky rings. ‘I’ve seen them all before. All of them. Mr Ahmed, a consultant from Kingston Hospital, came to visit me last year, to persuade me to go into hospital. He was a bit surprised. “You’ve got a touch on the chubby side, Mrs Tilling.” That’s what he said. Offered me the full à la carte: sleeve gastrectomy, gastric bypass, gastric band, intra-gastric balloon; but I said no. At that time, I was a little below 350 kg. That still exceeds the tolerance on their largest hoist. He looked around and admitted that I had more facilities here than the bariatric ward at his hospital, but he still wanted me in. I said no. Mr Ahmed went away and called in social services to assess me. They undertook a capability assessment, to see if they could section me. Could I look after myself? They could see that I had money and was earning enough to employ two private carers to come three times a week. They saw I already had a specialist bariatric toilet in a wet room, an industrial hoist that will get me from my bed to the wet room and back, the only journeys I have made in more than thirty years. Their only concern was assessing my diabetes and the sores on my legs and feet that refuse to heal. They had noted the fact that three months previously a carer had found maggots in a sore on the back of my left ankle.’ She pulled up the duvet to reveal a leg the size of a side of pork. A hand-sized dressing was taped on the enormously swollen and blotchy limb. ‘It’s a lot better now, but I have acres of eczema and other skin conditions between the folds of flesh. My carers find it extremely hard to keep me clean.’ She dropped the bedclothes back.

Gillard shook his head. ‘If you don’t go to hospital, you’ll die, it’s as simple as that.’

‘No, it’s not as simple as that. I showed my fan mail to the assessor from social services. Like I told her, if I went into hospital, I’d lose it all. My online show. All that affirmation. All that positive mental energy. I’d be depressed, less mobile, and with inferior physical care too. Social services agreed. I was fully capable and there was little they could do for me in hospital that could not be done here. In the end we reached a deal, the NHS and me. They simply stepped up the visits from the district nurse, who comes now once a week instead of once a month.’

Gillard looked again at the photos on the wall. There were many aged portraits of a smiling gap-toothed child, his hair carefully combed, freckles on his face. ‘Is this Robert?’ he asked.

‘Yes.’ Her voice was no more than a whisper.