difficult patients

full volume

~ jim clayton ~ 4 Comments

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.

head to head

~ jim clayton ~ Leave a comment

‘Shall I take my shoes off?’
‘No! Why? Why would you take your shoes off?’
‘I don’t know. It’s what I’d do at home…’
‘Are you at home?’
‘No.’
‘Is it raining outside?’
‘No.’
‘Then leave your shoes on and stop making such a fuss.’
‘Okay.’
Masha turns round in the narrow hallway and shuffles ahead of me down the hallway. I feel uneasy, like I’m being led into a cave by a ferocious old bear I’ve accidentally woken from hibernation.
‘Where shall I sit?’ I ask her, stepping into a bright and clinically tidy room.
‘Not in my chair!’ she says. ‘The sofa – perhaps.’
I put my bags down, take my jacket off.
‘There!’ I say. ‘That’s better!’
Masha sits on the edge of her armchair. She’d be an extraordinary figure in any circumstance – her hair dyed a rich, autumnal red and swept back off her head into something like a horn; her face slack and mournful – but illuminated as she is by the sunlight sparkling in through the window behind her, she seems hardly real at all, more like a brilliant, cartoon illustration from an article about a lonely clown. She reaches for a box of tissues, takes one out and starts folding it on her lap, over and over and over, into a tight little pad. I half expect her to reach for a pair of scissors, make a few adept snips, and unfold it to reveal a chain-word. грустный, perhaps. несчастье
‘How are you today?’ I say, throwing my hands wide, smiling as warmly as I can.
‘How do you think I am?’ she says. ‘Terrible. I am terrible.’
‘Oh! I’m very sorry to hear that.’
‘You’re sorry. Everyone is sorry. But no-one does a thing to help. So I am left here on my own, with nowhere to go, and nothing to do.’
And now I learn what the pad is for. She starts to cry – not an open sobbing so much as a discreet overflow of tears, oozing out through the myriad folds of her face, like her sadness was a water table of misfortune, high after a particularly long and inclement season.

Masha has a chronic condition that surgery hasn’t helped. She’s been in and out of hospital over the past few years, enduring several interventions that haven’t worked. This would be hard enough in itself, but the way Masha describes her experiences, it’s difficult to resist the feeling that her rather blunt way of talking has only made things worse.

‘…. an Asian consultant, he appeared at the bottom of the bed with a nurse, and he talked and talked without looking at me once, and at the end of all this nonsense he said Does that answer your question? So I said no it does not answer my question. I did not understand a single word you said. And I looked at the nurse, and she just clamped her mouth shut, like this… and shook her head from side to side, like this… and then they both went away. Later on I could hear them all talking about me in the office, because my bed was at the end of the ward. When the nurse passed my bed again I called her over. I told her I heard everything she said, and how she was a disgrace to her profession, and if I was in charge she could be sure I would throw her out, and good riddance. And she cried then, and everyone made a big fuss about it, but I’m not afraid of saying when something is wrong. Like yesterday, when I telephoned the hospital to find out why I had been forgotten, and the woman who answered the phone, she asked me what my problem was, and I told her I would not talk to her about it because what was she? A doctor? No – she was a silly little taker of messages who had no business asking intimate questions about someone’s health. And please would she fetch a manager, because I would not be spoken to in such a manner….’

And all the while Masha talks, she punctuates her sentences with a little dab of the tissue to the end of her nose.

She talks at great length. Her tone is curiously unsettling – self-assertive to the point of hostile, but with the occasional upward inflection that’s pitiful, almost childlike. She lists all the dreadful things that have happened to her, from rude reception staff and patronising community nurses to incompetent paramedics.

‘My sister said to me before I came to this country, she said Masha? You will find yourself in trouble over there. But I have never been afraid to speak the truth. I will not dress a thing up just so that people can feel okay.’

Masha pulls a fresh tissue from the box, and I take advantage of the pause to ask if she has any family nearby. She nods to a framed photo on the sideboard. It’s a photo of a young woman, forehead to forehead with a horse. On the left of the picture is the enormous eye of the horse; on the right, the young woman, her eyes closed, her left hand pressed affectionately to the angle of the horse’s jaw.

‘My niece, perhaps,’ says Masha, smoothing out the tissue on her lap and starting to fold it as meticulously as the first. ‘But she is busy.’