Sunday, 23 November 2008

Poor Sod

It is a black cold night in the docklands. The stars are icy twinkling pinpoints around a clear moon as we pull into the residential estate. It is far too cold for people to hang about and the street is deserted as Col and I get out of Col's ratty Escort to go and put Betty to bed. I am covering a night run, one of the youngsters has got her mother to ring in and say she is ill. I suspect this is not true and that a Saturday night on the booze has proved more attractive than a night of hoists and octogenarians but that is Monday's problem. Tonight there are people who need help and there is nobody else available so here I am. I don't know Betty so I ask Col what we are to do here, he grins at me and cocks his head towards the house and I hear a raised voice coming from inside. "Oh, I think I will let you meet Betty for yourself" he says.
I follow him up the driveway and into the large bungalow. John, Betty's husband, lets us in and I follow Col into a through lounge where a tall lady sits watching the banal blare of Saturday night television. She squints up at me and barks "Who are you?" I tell her my name is Caroline and she continues to glare at me as she repeats the name several times like an accusation "Caroline! Caroline!" I try again - "My mother's name was Betty" I say with a smile "My name is NOT Betty" she barks "My name is Betty Eileen Clark, Mrs. Clark to you!" I look to Col for guidance and he steps in front of me, speaking soothingly "Hello Betty, we've come to get you into your night things. Shall we go to the bedroom?" "Go to the bedroom!" she repeats these words with only marginally less aggression but she allows him to place a handling belt around her and bring her zimmer frame from the corner. Betty walks well and I feel a little foolish holding the belt and almost scurrying to keep up. I make the mistake of saying sotto voce to Col "can't keep up" and Betty whirls round fixing me with a look of such venom I step back "Did I hear you say why don't we push her?" she growls. I hastily deny this and Betty sniffs and turns to continue into the bedroom.
The tirade continues as we wash Betty and get her in to her pajamas. She isn't too bad with Col, snappy but fairly civil but the slightest move from me elicits a vituperous attack of such force that I end up standing three feet away, ready to leap forward if needed but staying well clear of the field of conflict. I realise that Betty follows a pattern, she repeats the last phrase said to her in a hectoring tone and offers the odd statement herself but it cannot be termed conversation, it is an aggressive attempt to maintain contact with her surroundings. She is also obsessed with where the elusive John is. He has melted away after letting us in and Betty constantly shouts "John! John! I'm coming through in a minute" The mild voice floats back from the living room with the merest hint of irony "That's good dear" She subsides only to repeat the statement a few moments later, with the same result. She turns on Col "I want to watch Ann Robinson" Col doesn't look surprised, this is obviously a well worn subject. "She isn't on tonight Betty" he says and she glares at him "No Aunty Ann?" she shrieks in outrage "Bitch!" "Very accurate" says Col with gentle sarcasm and Betty lunges forward in her chair, hands outstretched in claws towards his face. Col steps back until she subsides and then carries on with the task in hand.
By the time we take Betty back in to the living room she is shrieking for John again, demanding a cigarette and he is waiting with one lit for her as she reappears and is settled back into her chair. I momentarily wonder if this is a good moment to mention the smoking ban but decide that discretion is the better part of valour and the three of us retreat to the far end of the through lounge while Col fills in the communication book. Betty is on a loop now "John! John! I want a cigarette!" she keeps shouting. John's voice is gentle and resigned as time after time he says "You've got one Betty" or "Yes, Betty, you're smoking it now". He looks at me, sad blue eyes in a kindly face criss crossed with weary lines "Do you smoke?" he asks. I tell him I used to but have given up. "I used to many years ago" he says and gives me a wry smile "I think I may take it up again"
Col finishes writing in the book and we take our leave, John stands at the door until we reach the car and then turns back to the distant shouting from inside the house. I look at Col, raising my eyebrows. It feels like we have just walked out of a war zone, the silence of the freezing air seems like a blessed relief. Col raises his eyebrows back and smiles at me over the roof of the car as he unlocks the door. "Poor sod eh?" he says as he gets in. I look up at the indifferent moon shining on the roof of John and Betty's house - beneath that roof John is living out an endless life sentence of hostility with a woman who can remember nothing much except that she is furious. Poor sod indeed.

Monday, 10 November 2008

Mad Uncle Barry

One of the most frustrating things about doing this job is that we actually have very little control over how care is administered and managed. We can and do have our say but, ultimately, the decisions are ours to live with but not to make.
Iris has been an absolute beauty. A portrait of her in the lounge of her bungalow shows a woman with more than a passing resemblance to Elizabeth Taylor, right down to those amazing violet eyes. She is now in her eighties and is at an advanced stage of a dementing process. She is no longer able to speak and she can do nothing for herself beyond chew the food that is spooned into her mouth by her devoted son Barry.
I am asked to visit soon after care starts because, frankly, the care staff are terrified of Barry. The reports I have received are varied and bizarre, ranging from the video cameras Barry has trained on his mother when she is sleeping through to the fact that he insists all of the cutlery in the house is wrapped in silver paper in order to deflect the electronic rays that are being beamed into the house to monitor his conversations.
The bungalow is unremarkable, a large corner plot with a neat garden and a pleasant outlook. Barry answers my knock and ushers me into a large sunny living room with family pictures on a baby grand piano and furniture of the Waring and Gillow genre. It is the epitome of genteel and therefore serves as all the more startling a contrast to Barry. He is a small man, positively crackling with nervous energy who is wearing shorts and knee socks and has his hair in a long plait which bounces as he paces the room throughout our conversation. He is not hostile but his speech has the staccato delivery that tells of racing thoughts and what thoughts! He hurtles from subject to subject switching so seamlessly that he is almost impossible to follow. He believes his mother does not have dementia, she is suffering from post traumatic stress syndrome having witnessed a man having his head cut off when she lived in Kenya. He tells me he has been in the SAS and was tortured during guerilla warfare, rolling down his long socks to show me what is obviously a varicose vein as "evidence" of the injuries he received. There are lighter moments where he tells me his daughter is going to win X Factor and darker ones where he tells me that he is recording all of the things said by my home carers because, when he listens to them later, he alone is able to decipher the code words and hidden messages within their statements. I have worked in a mental health setting but even with no prior experience it is not hard to see that Barry is really very unwell, well, let's be honest, he is floridly mad. Having said that, Iris is beautifully cared for and she is my main concern. I just can't quite reconcile myself to thinking that it doesn't matter that Barry videos her all of the time just in case his enemies kidnap her and he tries to make the carers bring rubber boots to wear because his mother's powers are depleted by exposure to electricity.
I return to the office convinced that Barry must be known to local mental health services and indeed he is. He is known to Joanne the mental health social worker who tells me that his devotion to his mother is wonderful and she is very impressed. I control the squeak in my voice as I detail some of the things I have just observed and venture the opinion that Barry is really quite agitated and may not be totally to be relied upon to make the best decisions concerning Iris and her safety. Joanne does not agree, she says Barry is "eccentric but harmless" and when I ask if he has ever had any sort of diagnostic attention she as good as tells me to mind my own business.
She is right up to a point, as far as I can see Barry is harmless, and I get to see him rather a lot. Barry has decided that he loves me (thankfully in a purely platonic way) and he takes to visiting me at the office several times a week, usually with poor Iris in the car or in the wheelchair that he festoons with helium balloons, I hardly dare imagine why. I'm afraid we take to referring to him as "mad uncle Barry" - he burst through the door already talking and he attaches himself to the edge of my desk like a barnacle to tell me all about his news. One day he is a famous artist and has been exhibited all over the World, the next week he is writing his autobiography. I am, as you may imagine, thrilled to hear that I will be featuring prominently in this blockbuster and will receive my own signed copy. He always seems upbeat to the point of mania and I wonder if he has a corresponding downswing in mood, I almost long for it because, short of hiding under my desk when he appears (and I actually do this once or twice) there really seems to be no escape from my unwilling recruitment to Barryworld.
This continues for some weeks and then one day the carers tell me that Barry has taken to tying Iris into her chair. I visit and find this to be true, poor Iris is listing to one side in her chair and is bound up with what looks like a piece of washing line. This is a bridge too far, I ring Joanne and explain and she agrees to investigate. She rings me back later and tells me brightly that Barry feels Iris is less likely to fall if he ties her up and that this seems eminently sensible to her. I begin to wonder who is mad.....
Iris' bungalow is, according to Barry, the subject of a legal dispute between him and his sister, who lives in Australia. I don't ever find out if this is true but Barry suddenly moves Iris to his own house in the next village. This house is in a state of complete disarray, not least because he has taken most of the floorboards up in most of the rooms but again, Joanne says she feels Iris is fine, and I have to admit that Barry spends all of his time cooking for her and brushing her hair and generally looking after her, it's just that the whole set up is so bonkers that I cannot believe I am the only one who is worried. The move at least has the advantage that Barry stops visiting me as quickly as he started and gradually I no longer look up from behind my computer with trepidation when I hear the door buzzer go.
Weeks pass and things are relatively quiet and then, without warning, Barry cancels his mother's care. I ring up and question this but yet again it seems that I am the only person who is worried. As it happens, Barry's house is not far from where I live and I do see him pushing Iris in her balloon laden chair from time to time, once or twice I am ashamed to say I dive behind a display in the local Spar when I see him coming but at least I see that Iris still looks alright.
Iris died early this year. I saw the notice in the local paper and was amazed to read the roll call of extended family, I never saw any of them anywhere near her when she was alive but that is all too often the case. I agonise about whether I did the right thing in letting the issue go but the fact is, I did what I could, I am here to provide the care I am contracted to do, no more and no less. I expect I will never find out the circumstances of Iris' death, I console myself with the knowledge that Barry would never knowingly have let her come to any harm and she probably died as a natural consequence of her age and frailty.
Soon afterwards Barry's house was boarded up and remains so to this day. I have no idea what happened to him but I hope he is alright, he was curiously likeable despite his flights of fancy - maybe he has returned to Kenya to rejoin his regiment and sort out the civil war.....

Wednesday, 5 November 2008

Get the Vicar!

The area we cover is really a series of small towns and villages spread over quite a large area and thus managed in area teams. It is really interesting how different teams, although a scant few miles apart, have different personalities. At one end of the scale we have Atown. Atown is built around a docks and is a little down at heel. It specialises in lasses that look as though they were raised on pies and for whom no good night out is complete without a large quantity of alcohol, a kebab and a fight. The people are what I would call "salt of the Earth" types in general. They don't have much in the way of material wealth but there is a community spirit. Those who are a bit eccentric or even downright unwell are largely accepted with affection and the older people still live in communities where they are known and usually to some degree looked after by neighbours and extended family.

At the other end of the scale is Btown. If Btown was a human being it would be a middle aged lady who wore white cotton gloves and court shoes that matched her shiny leather hand bag. The bungalows look out on gardens that are manicured to perfection and the little market square boasts four different establishments where you can purchase ye olde scones and Earl Grey tea but nowhere you can buy a loaf of bread or a pint of milk. Btown has it's own eccentrics, there is an enclave of local artists who have studios in the area and can be seen drifting around in strange hats and Peruvian hand knit sweaters although, in Btown, this is probably termed "Bohemian" rather than "oddball". There is still a sense of community, our relative isolation as a County ensures that people know each other and have a sense of local identity, but in Btown there is more of an expectation that people will conform to social norms than there is at the other end of the scale.

Mabel was the local vicar's wife until he retired some fifteen years ago. Vernon is in his eighties now, a gentle scholarly chap who is a little vague but who still enjoys reading and spends a lot of his time tending his garden and feeding the birds that visit from the neoghbouring spinney. Mabel is also a little vague, unfortunately she is a little less genteel about it. Some people who are exhibiting signs of dementia will also become disinhibited. This is thought to be linked to deterioration in the frontal lobe of the brain. All I know is that, after a lifetime of the ultimate conforming role of vicar's wife, Mabel is kicking over the traces.

Some of the issues are distressing. Mabel will set out to go somewhere, often inappropriately dressed but always with her wicker shopping basket over her arm. I think that catching sight of the church triggers memories and she will suddenly appear there, distracted from wherever she was going by an urge to see Vernon. She completely forgets that Vernon is long retired and that she has just left him at home and she is then to be found crying in the church yard because she cannot understand why the doors are locked or, worse, bursting into a mother's meeting or a service and demanding to know where her husband is and swearing like a docker at the startled congregation. Even more worrying, Btown is something of a tourist spot and there are several buses to and from there which go all over the County. Mabel is quite fond of jumping on one of these buses and winding up thirty miles away with no idea where she is or indeed, who she is. This last was fairly easily solved when I hit upon the idea of circulating her photograph and details to all the police stations in the area and, more than once, Mabel has rolled up in the back of a squad car. She makes an incongruous sight, her hat on askew and her coat buttoned up wrong and her wicker basket on her knee, sitting with the bearing of Mrs. Vicar in the back of the panda car, but she never seems any the worse for her outing and dear old Vernon barely seems to notice she has gone missing at all.

The local people are generally pretty tolerant of Mabel, they let her go first in shops, because she sails to the front of the queue anyway and if they find her wandering and distressed in the town they take her home. There are mutterings about whether she "should be allowed to stay at home" but Btown people do not usually make a fuss out loud and the esteem in which Vernon is held ensures that any criticism is kept to a whisper. However, things have taken a sinister turn. Mabel has decided that the new vicar is an imposter and she has taken to stalking him. We now sit with her during Evensong. She retains the inner clock that tells her it is six o clock on a Sunday evening and, if left unattended, she will appear like the wrath of God himself and will charge down the aisle screaming obsceneties at the interloper who is impersonating her husband. At other times she lurks in the church yard and leaps out at the poor man as he walks up the path. He seems a lovely man and says he understands completely but I wonder if he is especially nervous this week.

Each year the Bishop comes to a service in the square on Rememberance Sunday. The great and good of the County gather to lay wreaths and remember those who fell in the service of their Country. This scene is enacted all over Britain, but I doubt anywhere else in Britain has a Mabel. Last year, the first of her vicar stalking obsession, she spent most of the service standing quite still, her eye fixed firmly on the poor vicar as he conducted the service with the Bishop. At the end of the formal service the Bishop worked his way around the crowded square, shaking hands and chatting to the townsfolk. Everywhere he went Mabel worked her way towards him, edging through the crowds and never taking her eyes off her quarry. When she finally reached the poor man she started to belabour him with her walking stick screaming to the Bishop "Look! Look! this man cant be a vicar - I was at school with him and he used to put his hand up my skirt!" Even allowing for the fact that Mabel is eighty and the vicar is probably forty at the most, it's still not in the top ten things you want your parishoners to hear is it? The Bishop was somewhat taken aback, Vernon, when told of the incident seemed mildly amused, a fact that may be due to his own memory loss or to the fact the Bishop is said to be not a terribly popular boss with his Ministers.

Anyway, It's that time of year again and the neighbours are suggesting we "do something". I expect we will have to do something, what I am not quite sure, but Mabel must be distracted. I can't help thinking it's a shame though. In Atown she would be just one more well loved local providing a bit of colour, in Btown she has crossed the line. The real shame is that if we sold tickets for the event we could probably raise enough money to fix the church roof. It was certainly embarrassing for the vicar but anyone who was there and witnessed Mabel hunting him down through the crowd with a light of battle in her eye had to admit that, it may have been inappropriate, but it was still rather funny.......

Wednesday, 29 October 2008

Counting the Pennies

They call the houses down there "Millionaire's row" the land was unadopted and each person built their own property according to their means and specifications. It's actually not a place that appeals to me, it's ostentatious, in places it's positively vulgar, and it lacks the patina and charm that age and natural development brings. There are Spanish style "hacienda" houses, their white stucco and curved lines incongruous in the Welsh drizzle, there are mock Georgian mansions with pillars and gravel so deep you could lose a small dog in it, there is even a futuristic creation with a slanting roof and aluminium window frames. We don't go down there much, people who buy or who build there tend to be younger and the help they need tends to be of the "little woman who does" type rather than the commode and catheter type care that is our stock in trade. Our one customer in Millionaire's row is Celia.
Celia and her now departed husband did not have children. They devoted their leisure to breeding St. Bernard dogs and their name was apparantly a byword amongst the dog show crowd. The dogs have been gone for some years but the room is still redolent of dog, the smell echoing a doggy reprise from all of the furnishings which hits you as you open the door. I first met Celia when she was brought home after long stay in hospital following a stroke. Her house is circa 1970 and looks like a fledgling architect was let loose with a sketch pad and an open cheque book. There are Gone with the Wind style curved steps up to a huge metal portico and the double doors open to more steps, wide enough to drive your coach and horses right on in and up to the first floor. The whole living area is built at first floor level, a huge through lounge with French windows at each end and a wrap around balcony that looks down on a terraced garden. It's very kitsch and totally useless to a seventy five year old lady with restricted mobility.
Celia and her husband had some neighbours, Bob and Linda, who lived in the houses that back onto Millionaire's row. Bob used to help Mr. P. with restoration work on his vintage car and he and his wife had become good friends with the couple. They were there to greet Celia when she returned home and Linda told me that Mr. P. had asked them to look after Celia "if anything happened to him" and that they considered her part of their family.
That certainly seemed to be the case. Bob and Linda's teenaged sons were often to be found in the house when we visited and Linda certainly kept in close touch, mostly to say that we had not carried the bin down to the gates or we had used a full pack of toilet rolls or some other spurious complaint. I have no way of knowing how much of Celia's condition dates from her stroke but she is certainly eccentric now and she has some very strange behaviours. Linda is supposed to clean the house but the place is festooned with little bits of toilet paper that Celia has spread around and the whole place is generally grotty. There is never a great deal of food either but we don't do the shopping and there is enough to get by, it's just ...not very appetising.
Celia cannot get down the grand staircase to go anywhere and, while it is true that Linda has taken her to have her hair done once every couple of months since she came home, she has been nowhere else. Celia has two pairs of knickers that we wash out each day, her slippers are so downtrodden that I am sure she is going to fall over them and her few clothes are all stained and worn. We know this lady has a considerable amount of money and we also know that Linda and Bob have full control of it. Celia will not hear a word about the subject. I do not know whether this is because she sees nothing wrong with the situation or because she knows that saying anything could potentially deprive her of the closest thing to a family that she has. She is right, always supposing we could get a court appointment to oversee Celia's finances, the consequence would almost certainly be that her neighbours would have no more to do with her and without them her life would be completely bereft of relationships. She is not being physically or mentally abused and I suppose that, while she is certainly not getting the things that she could well afford and that would make her life better, she is not being starved or deprived of basic necesseties. It's horrible but it is typical of abusive relationships with adults, you can remove a child, you cannot make that judgement with an adult who has the capacity to make their own decisions. You just have to stand there and watch and try to get stains out of her underwear in that grimy kitchen sink.

Monday, 27 October 2008

What a Prince

We have a system for new staff. They are interviewed and police checked and, once we know they have a clear record, they are sent out on shadow shifts. This involves going out with a Team Leader and meeting the customers to learn the routines. If somebody is new to the caring role they may need a full week of shifts, meeting each of the clients they will be visiting at least two or three times. Occasionally somebody is particularly nervous and they need an extra week of shadows before theTeam leader is confident they are safe to do the job alone.
Clare is twenty, a dumpy unprepossessing girl who seems young for her age. She seems keen to try the job out although she has no care experience and I put her with a local team to learn the ropes. Jane, the Team Leader, tries hard with her, she is a sweet girl and turns up on time but she has no instinct for the work. Jane comes back to me after a fortnight and says she doubts Clare will make the grade. She has to be told to do every little thing, nothing happens on her own initiative, left to her own devices she just stands staring into space. When Jane tells her to wash somebody and stands back to let her do the job, Clare dabs ineffectually at the customer's arm until she is told to get on with it, then she scrubs them so hard Jane has to intervene while the customer still has skin left. There is more. Jane is worried about the things Clare has told her about her life. She lives with her boyfriend and her year old baby but it seems an odd relationship. Clare's partner looks after the baby and Clare seems to have no say in anything. If Jane drops her at home and the boyfriend is out, Clare is locked out, she has no keys to the flat. The boyfriend rings her sometimes while she is working and she is immediately a gibbering wreck, agreeing with everything he says and making notes of the errands he wants her to do before she returns home.
There is no proifit in having a supernumerary member of staff. We are paying them to observe, to be additional to the carer who is actually doing the work. However, I overrule Jane and give Clare a further two weeks shadowing. The kid needs the break and instinct tells me that she is in for big trouble if she has to go home and tell the boyfriend she has lost her job. Clare doesn't improve, she seems to have no concept of what the job involves and at the end of four weeks my lovely blunt Jane says "Caroline, if you put that girl out on her own, on your own head be it, I wouldn't trust her to water a plant, much less to give someone vital medication." I still prevaricate, I send Clare out on a different team to get a second opinion. The second opinion bears Jane out, Clare is just never going to make the grade.
I had Clare in this morning and told her that we would not be continuing with her probationary period. She took the news like a whipped dog, barely responding and saying "thank you" as she left my office clutching an incongruous "Hello Kitty" handbag and looking as though she had no idea what was going on. I felt horribly guilty, as if I had done her a huge disservice in giving her a chance in the first place.
I wandered into reception after Clare left and was standing checking my post when the door was slammed open so hard it bounced back from the wall, barely missing my head. A man who resembled a warthog with tattoos hurled himself into the room and halted about six inches from me "Have you just sacked my effin' missus?" he bellowed. I was so taken aback I didn't understand what he had said at first and asked him to repeat himself. He did, even more loudly, "Are you the effing bitch who just sacked my effing missus??" The room shrank, there were other people there but I was only aware of his face, inches from mine, twisted in hideous rage. I said as calmly as I could "I'm not discussing this with you, I don't employ you and I have no intention of speaking to you" It was all over as fast as it had begun. He punched the screen by the reception desk, sending it flying across the room and slammed out into the showroom, kicking displays all the way to the door while he called me a selection of names that would make a docker blush. I leaned out of the reception door in time to see him hurtle out of the car park in his car, girlfriend beside him and, as I found out later from a carer who was just getting out of her car, with the baby in the back seat.
The incident was rehashed once we had all recovered our equilibrium and it was generally concluded that I had handled it with amazing calm. Actually, I was so shocked I dealt with it on autopilot. I listened as the day wore on and, in the way of offices everywhere, it became a wryly funny incident, a piece of office folk lore in the making and all the time I listened all I could see was Clare's white face as that car screeched out of the car park. It was a few frightening moments in my day....I hope that's all it was for Clare. I hope it was, but I am sure it wasn't.

Thursday, 23 October 2008

A tribute to Martine..and to Eileen

Eileen originally came to us as an adult protection case. She had been in hospital for several weeks after sustaining broken ribs, a broken nose and extensive bruising. She claimed she had fallen over a coffee table but it was generally thought that her husband had been responsible for her injuries. There was a long history of alcohol abuse and a generally chaotic backround and there was some suggestion that Eileen should not go home. She had various mental health issues and it was felt that the home situation was just not sustainable. However, Eileen had been successfully sober throughout her stay in hospital and was determined to go home and so, quite rightly, that was what was going to happen.
I remember the first case conference I attended at the hospital. Eileen was a handsome sort of woman with hair dyed an improbable black and piled into a bun and the sort of two piece skirt suit that always reminds me of the 1970's - all hectic flowers and glittery buttons. She was softly spoken and appeared nervous but she was completely able to make her own decisions and she spoke positively of her husband. He had visited her a scant few times but had told the nurses that he wanted her home and, since her injuries were healed and she was taking up a bed, things were put in place.
Initially we did very little, some nights they had been drinking but all was calm and we assisted Eileen into her night things and left. Some mornings they were not up in time for the call because they had stayed up very late the night before but generally the situation was unremarkable. Bill, Eileen's husband, was a gruff man who barely acknowledged the carers and he certainly seemed to be attached to his beer cans but he left us alone and we left him alone. Then three weeks into the care Bill literally dropped dead, no warning, no previous ill health, he just keeled over and was gone, a massive heart attack.
Ah the assumptions - somehow everyone thought that Eileen would be ok once she got over the initial shock and grief, after all, Bill was the author of most of her problems and surely life would be easier without the constant roller coaster of drink and drama. Eileen grieved deeply and painfully - she grieved for a man with whom she had had many good happy years and she grieved for the latter part of their relationship when things had been so truly horrible. She grieved for things said and done and for lost opportunities to put it right - and while she grieved, she drank.
We embarked on an eighteen month downward spiral of despair. Eileen drank all day and all night and she truly wished she was dead. The carers regularly found her in a soiled bed, wine bottle in hand, weeping copiously and hurting so much the pain seemed to permeate the fetid air of her bedroom. Slowly her sons became estranged by this sad parody of their mother who rang them day and night to scream abuse at them and was frequently found by police or neighbours wandering the streets in a soiled nightdress, still clutching the latest bottle of wine. It seemed to be an unstoppable decline and, as so often happens in these cases, the harrassed GP had no time for her, the alcohol services could not help her until she stopped drinking and her family washed their hands of her. This last was with some justification, I personally witnessed some of Eileen's screaming tirades to her sons and their wives, hurling obsceneties and ornaments at them after she had rung them and begged them to come.
One person did not give up though. Martine is an old school social worker and for once I wish I could use her real name because she deserves the accolade. She never gave up on Eileen, she visited every week or more often, she stayed with the pain and listened to the ranting and she fought tooth and claw to get anti drinking medication for Eileen, even after the GP refused it three times on grounds of futility and expense. Martine never gave up and neither did we but we all felt that Eileen would either die or kill herself and that the sad end was inevitable.
I don't know what made her turn the corner. Undoubtedly the medication Martine finally got helped but I think her belief in Eileen helped at least as much. Eileen stopped drinking. At first we were on a knife edge - she was horribly depressed and with sobriety came the realisation of what she had done to her family. Day added to day and week to week and as Eileen became used to not drinking her personality reasserted itself. She became quirky and funny and artistic, putting her mark on her house with throws and paintings and gradually replacing the things she had broken in her drunken rages. Her one great aching agony remained in the fact her family did not want to know her, did not believe in her epiphany because they had seen it all before, with her and with their father and they just could not take the risk of going through it again.
We are six months on. A few weeks ago Eileen rang me because she was having trouble contacting the incontinence nurse for her supply of pads. Her voice was strong and melodious and she joked that the nurse should be renamed the incompetence nurse and I put the phone down marvelling at the fact we had exchanged a simple joke and a laugh, how unthinkable that would have been this time last year. Last week marked the second anniversary of Bill's death and the first one Eileen had been through sober and also marked Eileen's birthday. The carers tell me that she had a visit from her youngest son, the one who lives nearest and the one who was most affected and therefore the most angry and intransigent in his determination to have no more to do with her. I rang Eileen and she told me there had been tears and painful conversation but that they were now talking again and the relationship had been resurrected. Eileen said Martine had been to visit her on her birthday too, "thank God for Martine" she said. Thank God indeed, I know her case load is huge and nobody would have blamed her if she had given up on Eileen, but she didn't.

Tuesday, 21 October 2008

Having a good moan

Grace lives alone in an isolated house that looks as if it was last modified around the end of the last war. She is ninety one and off with the fairies most of the time but she copes with four visits a day from us and a monthly overnight visit from her son who lives in Nottingham.
This morning Andrea went as usual to help Grace wash, dress and have breakfast. Grace may be getting forgetful but she knows what she likes and every morning she puts away bacon eggs and toast washed down with a pint of tea, food is one of the few pleasures left to her and she always tucks into breakfast with gusto. Things were very much as normal as Grace made inroads into her fry up - then Andrea went to get the medication - and discovered that Grace had taken three days worth before Andrea had got there. Now I am not a medic, but I know that three days worth of heart and blood pressure medication is unlikely to be a good thing, especially for a frail ninety one year old.
I rang the doctor and the poisons centre and the general consensus was that Grace should be taken to hospital and was likely to be extremely unwell, Grace, meanwhile was onto her second slice of toast and was about as inclined to agree to go to hospital as she was to part with the last of her bacon. I have every admiration for the ambulance service, in nearly thirty years I have only known them anything less than lovely on one occasion and today they lived up to my estimation. They arrived within the hour, even though the call was not an emergency one and they did their best to charm Grace into a ride to hospital. It looked as if they were going to be successful but, once in the ambulance Grace had a change of heart, conveying this fact by punching the ambulanceman right on the nose when he bent over to reason with her. Stalemate. The crew were reluctant to leave her but had no power to force her to co operate. Grace refused to get back in the ambulance and meanwhile Andrea had another five calls to do.
I rang around and conjured carers out of thin air to cover the calls (or at least that's how the task felt - staffing was as tight as usual) and Andrea and the ambulance crew spent a further half hour in negotiation with Grace before compromising with her agreeing to go so long as Andrea drove her in her own car and the ambulance followed behind and Andrea promised not to leave her or let her be admitted.
I then rang Grace's family and got her daughter in law. "Well this is most inconvenient" she said "Why couldn't you have rung an hour ago, Fred has set out for his monthly visit to his mother now and I wont be able to contact him" I swallowed the pithy reply that my crystal ball was faulty and I hadn't known a. that he was coming or b. that Grace was going to hospital an hour ago and apologised for the difficulty but Mrs. H. remained rather sniffy and was at pains to point out that this was extremely vexing. Hard on the heels of that phone call was one from the G.P.'s practice nurse asking why Grace had been allowed access to her medication. I pointed out that she has never touched her medication blister pack before in the seven years we have been going there and that we were not in the habit of hiding medication as a general practice. Besides, the medication had been delivered for the month before we got there that morning so we hadn't even seen it before Grace did her vanishing magic on the tablets. The practice nurse thought we were being at least naive and very possibly criminally negligent by not hiding the tablets and declared her intention of raising the issue with the Care Standards Officer.
All of this was at ten o clock or so. Andrea rang me back at about three to say she was bringing Grace home. We won't be paid for the additional five hours of Andrea's time although we will of course pay her. I spent a good hour of my day covering Andrea's calls and liaising with various medics about the issue and a further hour completing the necessary section 26 report for Care Standards because any abuse of medication is a notifiable incident. I have no doubt I will spend further time tomorrow explaining myself to the Care Standards Inspector. Grace is mad at us, we have wasted the time of the ambulance crew, Grace's family think we are incompetent and the G.P's surgery thinks we have been less than conscientious in our care. Some days I think I need a change of job...... Still, Grace is ok and that's the main thing - and we have hidden her medication...