Shades of Grey

Our brief is clear - we are there to meet the needs of the client. I should say here that "client" is, along with "customer", my preferred term for those we look after. Like so much else in social care, fashions change, and last year's term is this year's ageism - we can't say "old" we have to say "older" We can't use the term "suffers" as in "she suffers from Chron's Disease" because that is disempowering and the term "victim" as in "stroke victim" is a hanging offense nowadays for the same reason. In my experience it is those in boardrooms that worry about these distinctions, the "clients" themselves just want to be treated with respect and when I ask, as I always do, how they would like to be referred to in our documentation they usually react with at best indifference and at worst incredulity. Doris does not care what term we use, Doris does not care about much. She is stone deaf and far more worried about the fact that we won't leave her alone.
As I said at the beginning, we are here to serve the client and to see that their needs and wishes are met as far as possible. This is often far from simple because most people do not exist in isolation, they have family, and families invariably have their own viewpoint - a viewpoint that does not always meet harmoniously with that of the client.
Doris is ninety seven. I don't know whether she has been particularly lovely in earlier years or particularly domineering but my money is on the latter. She has two daughters, both in their early sixties and both professional people. Julia is an architect and Mary is a nurse. They both live many miles away in England but for the past five years and more they have taken it in turns to stay with their mother in her tiny one bedroomed council flat. Mary comes when her shifts allow and Julia fits in around her sister's hours. Neither has ever been married as far as I know. They both call her "Sunny", short for "Sunny Mummy" which is their pet name for her and they both have very firm ideas about what should happen to their mother, namely she should not die. Ever.
Doris has been in failing health for a long time, nothing specific unless you count chronic arthritis and a bad heart, she is just wearing out. Some months ago she had flu and had to be nursed in bed. The doctor was extremely worried about her heart and told us that she should be moved as little as possible. Each morning we had a stand off with whichever of her offspring was present when they demanded that she be got up to use the commode. This culminated with Julia screaming at me, so close to my face that I was wiping away her spittle. I maintained a calm exterior until she leaned into her mother's face with a similar attitude and started screaming at her "Get up Sunny, get up! This bitch says you have to shit in the bed if you don't get up!" I know I was overstepping the mark but at this point I grasped her arm and physically propelled her from the room, standing with my back to the bedroom door until she calmed down enough to speak reasonably, albeit through hysterical tears. The battles have been endless and exhausting. We wanted a profile bed ( a hospital type bed with a pressure relieving mattress that sits up electronically) to make movement easier for all of us and to protect Doris' fragile skin. They refused because they like to sleep with their mother and they dont want her in a single bed. Doris got a bit stronger and the doctor said she could be got out of bed for brief periods but she seemed to lack the trunk strength to sit up. Julia and Mary insisted we got her up. I said this could not be done safely without a hoist and a reclining chair, it took three weeks and the combined efforts of myself, the Occupational Therapist, the doctor and the District Nurse to persuade them to have the equipment. I wanted the chair by the bed, at least initially, they tried to insist we walk her down the corridor to the living room when she patently could not walk. They wanted us to use a handling belt and physically drag her - I refused on the grounds of my staff's well being and of the risk to Doris with her failing heart and her poor creaking legs. They bought a wheelchair and insisted she was put in the living room. Doris, slumped in a chair and seemingly unaware of her surroundings, now spends most of the day "keeping us company" in the living room. We wanted to change her pad in the living room, bringing a bowl in to wash her and thus only hoisting her once but they insist we take her through and lie her on the bed and then bring her back to her chair, putting her through the trauma of hoisting eight times instead. Each morning we arrive to find whichever of the daughters is there "exercising" Doris' legs, pumping them up and down and ignoring her cries so that she can take her weight when we put her in the chair. They have fallen out with every branch of the medical profession as, in turn, they tried to explain that Doris was highly unlikely to "get better" in the sense of walking independently again and now I am told they have hired a private physiotherapist to work with Sunny Mummy each morning. Sunny Mummy seems weary beyond measure and pretty much unaware of the drama going on over her bowed head.
I understand they love her and although I can't pretend I understand this hysterical refusal to believe that a woman of almost one hundred years has had enough, I accept they are not trying to be cruel. They are not trying to be - but they are and tonight, as I pray the private physiotherapist stands up to them and refuses to put Doris through futile painful exercises, I ask myself - Who's needs are being met here? - I'm pretty sure that we are no longer meeting Doris's.