full volume

Rita is sitting in a high-backed chair watching a veterinary programme on television. A cow is so bloated the vet is driving a cannula big as a marlinspike into its abdomen; the farmer and his wife put their hands over their noses. ‘She’ll be a lot more comfortable now,’ the vet says. They nod, keeping their hands in place.

The television is on so loud Rita hasn’t heard us come in, so as gently as I can I say Good Morning and move into her line of sight.

She screams.

I’ve met Rita before, and I’d told Andreas what to expect. It’s a particularly terrifying scream, though, and he visibly reddens.
‘It’s okay! It’s okay!’ he says. ‘We’re from the hospital. We’ve just come to see how you are and what you might need.’

She screams again – exactly the kind of sound effect you’d want in a horror film if an elderly person was being murdered. Such an open-throated and desperate noise, made worse by the slack cavity of her mouth and the two, blockish teeth, offset top and bottom.

The odd thing is, she’s not screaming because we’ve scared her coming into the flat. She’s screaming because she wants us to do something. And sure enough, when I ask what it is, she points to the kitchen trolley.

‘The remote? You want me to pass you the remote?’
She screams again.
‘There you are, Rita! And please try very hard not to scream like that if you can, because it makes it difficult to understand what you’re after.’
‘Thank you,’ she says, in a normal voice, and stuffs the remote into the cushion beside her on the chair.

My colleague Andreas looks shaken, but I think he’s reassured I’m not freaking out. He adopts a similarly calm, super-moderate tone.
‘Now then, Rita,’ he says, squatting down and resting a hand on hers. ‘I’m the physiotherapist, and you’ve met Jim before, the nursing assistant. Is it okay if we ask you a few questions to find out how we can help you after your stay in hospital? Would that be alright?’
She fishes out the remote control with her free hand again and raps him on the knuckles with it – I guess because he’s in the way of her vet programme.
‘Oh! Sorry!’ he says, rubbing his hand and standing up again. ‘But Rita – would you mind if we turned the television down a little bit? So we wouldn’t have to shout?’
She screams again, and he almost falls over.
‘Now, now!’ I say. ‘Come on, Rita! Remember what we said about the screaming? Try to tell us as calmly as you can what it is you want.’
‘Soup!’ she says. ‘I want soup!’
‘Okay. That’s okay. I’ll make you some soup’ says Andreas, ‘but first let’s get the assessment out of the way, shall we?’
She turns off the TV and grumpily stuffs the remote into the chair cushion again.
Andreas has just turned his back to open his folders when she screams again, so loudly he almost dumps the lot on the floor.
‘What is it now?’ he says.
‘Clean these!’ she shouts, handing him two filthy magnifying lenses. ‘Clean them!’
‘Okay. I’ll rinse them under the tap for you, but then I really must get on with my paperwork. Okay?’
He takes the glasses, shakes his head at me, then goes into the kitchen.
‘Whilst Andreas is doing that, d’you mind if I take your blood pressure and so on?’
She grunts, staring at the television.
A rabbit is being sedated prior to an operation. The vet says he’ll take this opportunity to clip its nails, too.
I approach with my kit, gently wrapping a blood pressure cuff round her arm, and then putting the steth in my ear. Just behind her I notice a yellowing, photocopied picture taped to the wall – a Welsh terrier, sitting with its paws on a table. The dog is wearing pince-nez specs, a red spotted neckerchief and a knitted waistcoat. ‘He’s lovely’ I say, nodding at the picture. What’s his name?’
Rita screams.
It’s completely heart-stopping, like I’ve put the stethoscope into the mouth of a roaring lion. I snatch it clear and take a step back.
‘What?’ I say, shakily.
‘A girl!’ she says, in her normal voice. ‘She was a girl’.
Then she picks up the remote control, points it at the TV, and turns it up, full volume.

4 thoughts on “full volume

  1. Dear God! I would have to hope the woman developed some sort of minor issue that kept her from screaming but still allowed normal speech.

    As humans are hardwired to react to such an alarm in exactly the way you described (with the release of adrenaline), it must take a bit of time for you to calm your nerves after leaving. I’m also nearly as certain that there are people who might actually hit her when she does it as theirs is a fight instead of flight response and, again, it’s hardwired. They would do so the first time they experience it and prior to their being able to actually process it. Telling someone about it obviously cannot prepare them as your coworker’s reaction proves. Of course, your handling of it was excellent as you were obviously closer to her when the first scream happened.

    You’re a better man than I, Jim Clayton 😜


    1. A visit to Rita will always leave you feeling a little twitchy! She’s not too bad once you get used to her, but it’s a shock to begin with – and even then she can catch you out! Mind you – I was crazy to mention the dog-on-the-wall whilst I had the steth in my ears! Rookie error!
      I think you’d handle this scenario (and all the others) just fine. I think all you need is a curiosity about people & a humane streak – and I reckon you have both in spades!
      Thanks so much for the comment, as always, Patti. Hope all’s good with you & yours


  2. My mother in law had Alzheimer’s. we went to a ‘family meeting’ at the care home she was in. We heard this terrible guttural screaming in the next room it seemed like a howl of abject fear. The manager calmly said to my husband “oh, that’s your mum, she does a lot of that” I can’t you how bad that made us feel. She had been a quiet , meek woman, scared of her own shadow one might say. Dementia robbed her of that voice and gave her a new, uninhabited voice. A voice so loud and visceral, it seemed like all her life’s regrets came out of her in one terrible roar. There was nothing we could do to calm her, to make her feel secure. It was as if she was stuck in a nightmare and the only release was not to be here anymore. I will never forget that scream.


    1. Hi Sally

      So sorry to hear about your Mother in Law. Alzheimer’s is a truly awful thing to deal with, both patient & family. I hope you found the support you needed, and a way to come to terms with it all.

      In Rita’s case her scream was more a learned behaviour. She’d lived alone for a long time – quite a hoarder, in many respects – and she was struggling to adjust to normal interaction. It was a blessing that she could respond to a calm approach, but she was difficult to handle.

      It’s easier as a health care professional, though. You can maintain a certain detachment that’s impossible as a relative. It’s always a thousand times more difficult if it’s your own family.

      Thank you so much for writing and sharing, Sally. I hope you & your family are well.
      J x


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