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.......