SCOTLAND ZEN and the art of SOCIAL WORK

by J.A. Skinner

  Chapter 26

  Still Friday 30th May

  The exact way HD affects an individual varies and can differ even between members of the same family, but the symptoms progress predictably for most individuals. The earliest symptoms are a general lack of coordination and an unsteady gait.  

  Monday morning, it is cold dreich and cloudy. It’s only the beginning of June and the summer might be over. Clair Murray, a social work colleague, is sitting at my desk. She is perfectly pleasant to look at. She is small, dainty and has very short blond hair and blue eyes, magnified by smart modern rimless glasses. She is thirty two, married to a fireman because, as she often says, she loves the uniform. She has two children, eleven and twelve, both at high school. She was obviously a child bride, an early starter.

  How she manages to work full time and do another full time job at home is beyond me, but she does, and very competently. Of course, all I know about is her day job. She says she compartmentalises her life, and each box she gives all her energy to for some part of the day. She admits to having no box for housework, and feels that untidiness is healthy and normal. This is why she can sit comfortably in my room and she would feel robustly healthy and normal in my flat. I am a sloth compared to her, but I never fail to praise women for being different to men. They are not just a different sex, but a completely different species.

  She has a report from the weekend response team in front of her about the baby in Monklands with the head injury. She wants me to have a read and then go with her to visit the hospital, speak to the staff and then the parents and see the child. The report is by a weekend worker called Brian Shannon, an Irish charmer who writes his reports at seven in the morning, the end of his night shift, as they have to be passed on to the day teams immediately, usually for some action. Unfortunately Brian has no administration back-up at that ungodly hour, and he is usually very tired, so the reports tend to be brief, concise to the point that they seem to be only a glimpse of what really happened.

  Basically the nine month old child was brought to hospital on Thursday evening with a head injury and no clear explanation by the parents what had caused it. The child had a temperature and had a mild petit mal seizure while in the hospital, and was kept in for observation. It was deemed a suspicious injury by Friday evening when no explanation was forthcoming for the injury. Good old Brian, no assessment on the parents, no Doctor’s report, and no health visitor contact details attached to his notes. No problem, Clair and I are bright eyed and ready for the fray. This could end up a very bad situation, so two experienced social worker heads are better than one, and if the police become involved, it’s good to have a partner and witness for corroboration.

  Clair and I have worked together before, she has a caring, sympathetic soft approach, whereas I tend to state thing baldly. I have been known to look a parent in the eye and proclaim,

  ‘Your children are damaged because of the atrocious care you’re giving them.’ This doesn’t win friends, but it saves a lot of time waffling. We slip into our usual roles, I offer to do the driving and in return she will write up the case notes. She starts writing in her notebook as soon as we get in the car, times, dates and workers involved, she doesn’t idle. We arrive at the hospital half an hour later and are directed to the casualty wing. The place is very calm this morning just an elderly couple sitting quietly as if they have been there long enough for dust to settle on them, and a mother pacing the floor with a whinging baby. We speak initially to two burly male nurses, they ask us for our identity cards and we would not dare to argue, presumably they are hand picked by size to compensate for the lack of security at the busy times. One of the nurses, Robert was on duty when the infant was brought in on Thursday night but didn’t have much detail except for the name of the Doctor who attended to him. We track Doctor Sharma to a tiny cubby-hole office with just enough room for a desk, chair and a narrow single bed. If your office size is comparative with your status, this guy was on the ground, before the first rung of the ladder. Maybe it’s true that Doctors are treated deliberately badly at the beginning of their career, to train them how to treat their patients, but I’m not really that cynical.

  Clair and I stood in the doorway with the door wide open so that we would all have enough air to breath. The Doctor introduced himself as Ali Sharma. He apologised for not asking us in, unless we wanted to sprawl on the bed. We declined, although Clair had gone a bit pink and giggly, she might have liked to sprawl on the bed with Doctor Ali. Of course, she is a sucker for a uniform, and handsome Ali was dressed in white cotton trousers and a white Doctor Kildare type jacket, which at a stretch, could be construed as one. I said we needed information on one of his patients, Ryan Thomson.

  ‘Why don’t we sit down together in the canteen, get a coffee and talk about this?’ he said and picked up a thin blue file from his desk.

  When we were all settled with drinks, Doctor Sharma said,

  I’m off duty in fifteen minutes, I’ve been on duty since Thursday at six, so I’ll make this short.’

  How could he still be functioning after a shift like that? Amazing! After a brief look at the file, he gives us the story of Ryan being brought to the hospital by both parents at eight o’clock in the evening, crying and feverish with a slight bruise on his right temple. The mother said she thought he had been unconscious in his pram. It had been very difficult to wake him for his nightly bath and drink at seven. They had been out shopping earlier and Ryan had fallen asleep in his pram. When they got home they let him sleep on, so that they could have the luxury of dinner in peace. The mother had to shake him awake later and he woke up really cranky and hot. She noticed the bruise on his head and phoned her surgery, who advised her to come to casualty. Ryan had been admitted for observation, given Calpol and water. He seemed fine on Friday but had a small seizure at two o’clock Saturday morning.

  Doctor Sharma had alerted the emergency duty social work team who decided Ryan was safe where he was for the weekend. The Doctor was very clear that he thought Ryan’s injury had been serious, as head injuries in babies usually are, but he was now recovering well. He could have been discharged today if there had been any reasonable explanation for the bruise on his head.

  ‘In my experience, babies of his age don’t get injured unless they fall off something, or something falls on them, or someone hits them. The most likely explanation in this case was he was hit, deliberately or accidentally I don’t know, on the side of the head. He seems right as rain this morning and the Mother is on the ward with him as she has been all weekend.

  ‘Is he teething?’ asked Clair. Doctor Ali looked blank,

  ‘Because the fever and the fit could be caused by a teething temperature, I know it doesn’t explain the bruise, but if he’s been screaming with sore gums for a week the parents could be stressed out.’

  ‘Well, you might be on the right track but my shift is over, and it is up to you what happens now. We left the very tired Doctor Sharma to make his way home to bed, possibly fantasising of a bath, cool cotton sheets and twenty hours uninterrupted sleep.

  When we get to the ward, Clair and I are asked for our identity cards again, we are beginning to feel like C.I.D. When we tell the charge nurse who we are here to see, we are given a rundown of what a lovely wee boy Ryan is, and how wonderful and dedicated his Mother Rebecca has been. She hasn’t hardly left his cot all weekend. This wonderful, motherly Rebecca might have narrowly missed killing her child with a blow to the head, but it’s nice to know she has made a big hit with the nursing staff.

  Ryan’s mother was with him on the ward now as she had been, practically all weekend. On the children’s ward everything is way too bright and cheery. Bold primary colours and Disney posters are all over the place. There is the usual notice board full of gushing letters from patients and parents praising the nurses to the high heavens for doing their job. I don’t know of any other profession which has to put on display all this adoration from anxious, vulnerable, people. I don
’t know why they’re not all morbidly obese from the barrow loads of chocolates that get handed in for them from their fans. I don’t much like nurses, a fact that Clair is well aware of. The nurses here are walking about the ward hyperactively, I’m sure this is due to the high sensory impact. Clair, the diplomat thanks nurse drivel, and we get to see Ryan at last.

  He is a small boy for nine months and thin, but he is standing up in his high sided cot, holding on to the bars and bouncing up and down. The bruise on his temple is grey and purple and stands out starkly against his white skin and fair wispy hair. We introduce ourselves.

  ‘Oh God, not more social workers, I already spoke to an Irish man on Friday, what do you want now,’

  How gracious, Clair patiently explains that we just want to make sure Ryan is okay,

  ‘Believe it or not we’re on your side Rebecca, we want what’s best for your son, just the same as you do. We want to make sure he’s safe.’

  ‘Of course he’s safe, are you trying to say he’s not safe with us?’ she sounds panicky, and is holding the rungs of the cot like a white knuckle ride.

  This is not going too well, she’s getting defensive, my immediate feeling is bad. The charge nurse approaches us and asks if she can have a word with me. I’m not pleased with this interruption and storm up the ward after her. When she gets to her desk she hands me the phone with a saccharine sweet smile,

  ‘An urgent message for you, from your office.’

  Oh, shite! My first thought is that Kate and Phillip have decided they don’t want twins, surely not. Maybe an emergency at the office, but I’m out on an emergency. I can’t be two places at the one time, I take the phone.

  ‘Hello Tommy, I’m sorry to be calling you when you’re busy but there’s some bad news.’ This is Aileen, without even a ‘honey bunch’ it must be serious. I stand very still and all the sounds and colours of the ward seem to fade to nothing.

  ‘What, what is it..?

  ‘Your Mother is in the casualty department, she had a wee accident this morning, she apparently fell over and one of her neighbours called an ambulance for her. I’m sorry, I don’t even know if it’s serious but…’

  ‘Thanks Aileen, tell Wang where I’ll be, call you later.’ I hung up and started to stride out of the ward really shocked, then I remembered what I’d been doing and turned back and told Clair I had to leave her on her own, she could find me in the casualty when she was finished. She didn’t bat an eyelid, didn’t ask any questions, good social work training, unflappable.

  I was near to panic in the lift, it wasn’t moving fast enough for me. My Mother would do any thing rather than cause a fuss so I have a feeling this could be bad. I show my identity card to skip the queue at the information desk, and a harassed receptionist tells me to go to cubicle four. The department is busy now, with some raised voices and clanking trolleys and white-coated staff purposefully walking about. I eventually find cubicle four and I’m almost scared to pull back the curtain to go in. When I get the courage I find my Mum is lying on a trolley bed seemingly asleep and our neighbour Mr. Lafferty is sitting on a chair beside her.

  ‘Tommy, good man, how did you get here so fast?’

  ‘I was here in the hospital already.’ In fact I don’t know how I missed them coming in. I passed through here not half an hour ago. I was probably sitting in the canteen drinking coffee when they arrived,

  ‘What happened?’

  ‘Not really sure son, we were having a natter out the back, your Mother was putting her rubbish in the bin when she tripped down the last step at the back door. She hurt her ankle and wrist, they might be broken. I kept staring at my Mother not knowing whether to wake her or not.

  ‘She didn’t want me to get an ambulance but her speech was a wee bit slow so I kind of forced her into coming in for a check.’

  ‘Thanks a lot Mr. Lafferty, you did exactly the right thing, she looks out cold, what did they give her?’

  ‘Nothing, as far as I know, the doctor will be back soon, he’ll fill you in.

  I feel a cold dread creeping up my chest, her speech was slow, she’s had another stroke God help her, I hope she comes out of this. I took her hand and gently shook her fingers. She slowly opened her eyes as if this was a mammoth task, but when she saw me she smiled, sadly this was a bit lopsided and one eye drooped slightly,

  ‘Oh son I’m so glad you’re here, I think I fell over.’ At least that was what she tried to say, but the words were her enemy now, sliding all over the place. I felt the urge to scream and shake her back to normal, but managed to keep a smile on my face, seeing but not believing that this was worse than the last time.

  ‘Can you take me home now son, please?’

  ‘Of course, I just have to check with the doctor first, you try to sleep. Can you wait on please Mr. Lafferty? I’ll be back as quick as I can.’

  ‘Sure son I’m not going anywhere.’

  I left the cubicle and took a deep breath to try to gather some calm. I’d always known that my Mum could have another stroke but never thought I would have to face up to the reality of it. The thought of losing her is just not bearable. She is the only person in the world that I love and she is the only person in the world who loves me. I feel my throat pulsing with fear and stride about looking for a doctor. This proves to be an impossible task and it seems there is nothing I can do but wait. A nurse appears in front of me, a female, not one of the burly ones.

  ‘Can I help you?’

  ‘Yes, my Mother is in cubicle four, I need to speak with a doctor.’

  ‘Yes you do, we’re waiting for her papers to come down from the records department, and she’s been here before?

  ‘Three years ago she was here for a short stay, she had a mild stroke…’ my voice starts to wobble and I clear my throat a few times to make room for the difficult words,

  ‘She’s had another one hasn’t she?’ the nurse pauses and looks at her watch,

  ‘Why don’t you wait to speak to the doctor? He won’t be long, best if you wait in the cubicle.’

  This is exactly what I hate about nurses, and I’m in no mood to tolerate this one.

  ‘Look I’m not stupid, I’ve just spoken to her, why are you so shit scared to commit yourself? Do you just hide behind the doctors all the time?’

  ‘I think you’re a bit upset Mr…’

  ‘Correct! I’m upset, how observant of you, part of the training is it? Luckily a doctor comes bustling along the corridor with a porter following him pushing a trolley of files. The nurse stops him in his tracks,

  ‘Mrs. Jones’ son, Doctor Keith, anxious to speak with you.’ She glares at me and stalks off briskly. Doctor Keith waves me along with him and we turn into his office just off the middle of the corridor. He rakes through the files on the trolley, takes out one and asks the porter to take the rest to the nurse’s station. The doctor looks about sixty, he has white hair and Paul Newman blue eyes, he is tall and broad and comfortable looking. I’m tempted to ask him how long he has been on shift, as I don’t want anyone tired and burnt out dealing with my Mother. I narrowly manage to keep my mouth shut. He closes his office door and asks me to sit down but I can’t. I want to hear what he has to say, but at the same time I want to run back to my Mum. He just nods and takes a quick look at the paperwork,

  ‘We’re going to move your Mother up to ward ten,’ he says quietly, ‘we need to keep a close eye on her for the next twenty four hours.’

  ‘She’s had another stroke?’

  Yes, and she might have another one, we’ll do some tests but we already know she has some real weak spots which could cause another bleed. There might be some bleeding already behind her left eye.’

  I feel the floor shift beneath me and urgently need to sit down, at eye level I can see that his expression is grave. He’s being very clear with me but I can’t seem to assimilate the information.

  ‘How bad it this?’

  ‘Its bad son, I’m very sorry.’

  I felt
a door closing inside me, my whole life seems to have changed with these few words. I can’t stand the sympathy. I don’t want him to say anymore. I get up to leave the office when I remember,

  ‘What about her injuries, her wrist and ankle?’

  ‘Nothing’s broken, she’s not in any pain, just stay with her, she’ll be moved shortly.

  Back in cubicle four everything is peaceful, Mum is quiet, and Mr. Lafferty is dozing in his chair. I touch his shoulder gently and his eyes fly open,

  ‘God love us, look at me falling asleep on guard duty, sorry, but I usually have a bit of a kip at this time, old age doesn’t come alone. How are things, is she going home?’

  ‘No, she going up to a ward for observation and some tests, I’ve spoken to the doctor, maybe you should get off home now, I’ll be with her for a while.’ Bad thoughts spin through my mind, I’m going to be here for a while, or I’m going to be here to the end. Mr. Lafferty gets up to go then hesitates,

  ‘I know this is a nuisance son but I came here in the ambulance and I’m not sure where I get the bus to Motherwell now. Poor old soul, doing a favour and being cast adrift in Airdrie, he probably hasn’t been this far from home for years. At least I can fix this.

  Just you wait, my car is in the car park and I know a nice young lady who will chauffeur you home.

  I nip out of the cubicle, run along the corridor, up two flights of stairs to the children’s ward and meet Clair coming out of the door. We manage to catch the lift down and I quickly explain to her about my Mothers condition. I also say that she will have to drive my car to Motherwell, deliver Mr. Lafferty to his house, take my car to the office and leave it there, give the keys to Harry and make sure he puts them in the exhaust pipe before he goes home, and ask Aileen to deal with anything important till I call her.

  ‘That’s a dawdle Tommy, just you stay calm and don’t worry about anything except your Ma. I could have kissed her, and cried my eyes out, she’s a star, but the lift opened and I walked back out to reality.

  ‘What about Ryan, did you get any further?’

  ‘As a matter of fact I did, apparently dad put him in his pram a bit roughly as he had been crying for about two hours, teething as I thought and they couldn’t get him to sleep. He bumped Ryan’s head sharply off the hood, and he cried a bit more. He eventually fell asleep. That’s when they decided to go shopping and then have dinner without the wailing they had been listening to on and off for the past week. I believe it was an accident, they’re very inexperienced, but they were so scared to tell anyone what had happened they put the baby at risk by covering it up. You put it all out of your head right now. I’ll call a case conference; you’ve got enough to worry about right now.