It was a stressful start.
The team meeting had quickly deteriorated into a bitter ‘team dressing down’. The senior clinicians had closed the service the day before, and the manager was trying to figure out why. The figures were tight but they’d been tighter. We had good levels of staffing. She was furious. What made it worse was the way she expressed her fury – more a kind of intense disappointment. She had faith in us and we’d let her down. She’d gone away on a training course because she’d been confident we’d be able to cope. We hadn’t even phoned her before making the decision to escalate and close the service to new referrals.
We hadn’t even phoned.
On top of that, the workload was as brisk as ever. I had six patients to see, a couple of them known to be complex, all of them spread around town. The meeting had made everyone late. I knew it’d be a struggle to get round in time. I did what I could to prepare, and hurried out to the car.
I thought I’d tackle the most difficult case first – Jeremy, a vulnerable elderly man new to the area who’d stopped taking his meds and was being worryingly uncooperative. He’d thrown one of the nurses out yesterday, and I was tasked to go in with as much tact as possible and find out what was going on.
I knew the block, so that was one advantage. I went straight there avoiding the traffic and parked up in the little parking area round the back. Jeremy didn’t answer his buzzer, so I phoned instead. He shouted at me when I said who I was but didn’t hang up. Just as I was finding some angle to try to persuade him to let me in, the scheme manager opened the door.
‘Have you come to see Jeremy?’ he said.
I was relieved. I told Jeremy not to worry, and if it was all right with him I’d come up and say hello. Then I picked up my bags and went in to the lobby.
‘Where’ve you parked?’ said the scheme manager, pleasantly.
‘Just round the back,’ I said.
‘You’ll be clamped.’
It was such an abrupt change in the tone of the conversation I laughed. I thought he was joking.
‘I’m serious,’ he said. ‘You’ll be clamped and fined.’
‘But – I’ve got a permit.’
‘I’m a health visitor. I’ve come to see a patient.’
He shook his head.
Stress is a cumulative thing. It builds and builds and then something happens, big or small, and the switch is thrown and it all comes out.
If you’d asked me, when I was standing outside the building in the freezing wind, listening to Jeremy shout at me down the phone, thinking about the team meeting that morning, thinking about all the cases I had to see that day and how on earth I was going to fit them all in – if you’d asked me at that specific moment how I was feeling, I would’ve answered, quite honestly, fine. A little wired, maybe. Pumped-up, ready to go. Okay. And suddenly here I was standing in the lobby of a housing block, shaking.
That’s the nature of stress, though. It takes everyone by surprise, not least you.
I dropped my bag.
The scheme manager took a step back.
‘I’m a nurse!’ I said (I’m not, but it sounded shorter and punchier than assistant practitioner). ‘I’ve come to treat a patient. And you’re telling me I’m going to be clamped and fined.’
‘It’s a new thing’ he said.
‘Well – great! Lovely! Let them clamp me! And if they do I’ll quit. And I’ll leave the country. Then maybe you can take over and see to the patients.’
‘I’m just saying…’
‘Just saying! For God’s sake! What are you like? Seriously? Go on! Go and call the clampers! Lock me up! But before you do, I don’t suppose you’ll mind if I go up and look after my patient? No? Thank you very much.’
I headed for the stairs. Before the door closed behind me I heard him say ‘I’ve got a permit in the office if you’d like it…’
Turns out, Jeremy wasn’t aggressive so much as deaf with an abrasive manner. His meds were deranged, as was the flat. There were practical things to be done. I took blood, reassured Jeremy that nothing would be done he didn’t want to do, made plans, and left.
The manager wasn’t around in the lobby – which was a shame, because I wanted to apologise for losing my temper. It struck me that his intention had probably been just to warn me they’d changed the management of the car park, and I’d need a special permit. Parking is terrible round there and I know they must have problems. So the new regime was probably justified (although you’d think they could make allowance for vehicles with certain badges). Annoying, definitely; pedantic, perhaps, but hardly an expression of hostility towards me, or the NHS.
I threw my bag in the car and took the permit off the dashboard.
Maybe I should have another badge – one that says ‘Caution. Under stress.’
And a little tin of travel sweets, filled with Valium.
I tossed the permit onto the passenger seat along with the rest of my junk, checked the map, and hurried off to the next call.