Agnes is lying on the floor where she slipped out of bed sometime in the morning. She hasn’t hurt herself. There’s plenty of room and she has some strength in her arms and legs, so it’s an easy thing to use the inflatable cushion and get her up. She stands, stiffly but well enough, walks unaided into the front room where she sits in her chair with an appreciative sigh.
‘That’s better!’ she says. ‘I’ve landed!’
Ian, her PA, watches from the doorway.
‘This can’t go on!’ he says. ‘You didn’t have your alarm on again. What have we said? Why didn’t you have your alarm on?’
Agnes looks at me and winces.
He’s off again! she says.
Ian folds his arms.
‘It’s all very well you saying this stuff but it’s not going to make things better is it? I’ve been on and on at the daughter but she won’t listen. Agnes has been falling a lot lately. She won’t use her frame properly, she forgets to wear her button. Her memory’s shot and I don’t get any extra help. I’ve had endless arguments with her but it doesn’t do any good...’
He steams on in this vein. I ask him to fetch in Agnes’ medication, just to get some space to ask Agnes if everything’s all right.
‘Don’t mind him,’ says Agnes. ‘He gets a bit worked up sometimes.’
It’s a strange situation. The flat is neat and tidy. Agnes seems happy enough in herself, and we haven’t seen any signs of bruising that might indicate physical abuse. She’s warm, well-fed. There are rails on the walls, a wet room, toilet surround, walking aids. The daughter’s already been on the phone. She sounded caring, interested, in touch. Ian’s stress seems completely disproportionate.
He comes back in with the blister pack and hands it to me. His face is taut, waxy; his expression guarded. I wonder for a minute if he’s about to cry, but he launches into another bitterly intense description of the state of affairs. I have to speak over him to have a chance of asking specific questions, or finding out how things stand.
‘What’s the difference between a Personal Assistant and a Carer?’ I ask him.
‘Nothing. Nothing at all. It’s exactly the same job, for what that’s worth, except it’s a private arrangement between me and the daughter. I used to work for an agency, but they took me on full time, shoot me now. It’s just me, doing everything. The daughter comes round now and again and gets in the way. Quite honestly it’s a miracle I get anything done. I don’t think she realises...’
‘It must be very stressful for you,’ I tell him. ‘You’ve obviously got a lot on your plate.’
He launches into a long, scattershot complaint, covering everything from shopping arrangements to difficulties with the new bed, missed appointments, misunderstandings, unsatisfactory consultations with the doctor – and at every point, standing at the margins of his unhappiness like some malign shadow, the figure of the daughter.
Ian must at one point have been a good match for them as a family. There’d be no other reason why they’d take him on as the single carer for the mother. But it’s hard now to see why that would have been the case – and equally hard to understand why he’s still there. Surely the daughter can’t be unaware of his level of discontent? Or is this new today?
I suggest to Ian that we make a Falls Referral. I tell him I’ll make a note that the level of care also needs looking at.
‘Good luck with that,’ he says. ‘It’s not as if I haven’t tried.’
‘Well it can’t hurt if we add our voice.’
We say goodbye to Agnes and head out.
‘I need a smoke,’ he says.
He goes as far as the grass verge, then lights up and starts pacing around, shooting us glances, smoking furiously, intermittently checking his phone.
‘Oh my God!’ says Rae. ‘What’s he like?’
‘Maybe I should phone the daughter?’
‘It’s difficult, isn’t it?’
‘Or do a Vulnerable Adult report? But that gets social services involved, and she doesn’t seem all that bad.’
‘The Falls Team are pretty good, though.’
‘I’ll make sure I put some notes on the job.’
‘Yeah – like come with a net.’
I make the referral. I’m a little uneasy about the whole thing, but at least someone’s coming in. After all, maybe this is just a particularly bad day for Ian, and we don’t want to stir things up unnecessarily. It’s never clear cut.
When I’m done I put the clipboard on the dash, glance over to Ian again and wave.
He nods, takes one last drag of his cigarette, flicks it away into the road and then exhales such a cloud of smoke it looks for a moment as if his head has exploded.
Then he turns and marches back inside.
This is one I wish you had follow-up information on; I want to know what happens.
Me too! I'd be curious to know what the Falls team made of that scenario. Hopefully whatever it was that was stressing Ian out so much would've resolved. Of course, the worry is that he was reaching the end of his tether. I'd imagine that some other care arrangements would just have to be made.
You might be better off checking Ian's obs than Agnes'.I'd suggest his bp might be a touch high.
You're right. In retrospect he was probably much more the patient than she was!
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