The pharmacist, p.7
The Pharmacist, page 7
As it happened, Alice seemed very much brighter when Sarah did pop into her room that morning and nothing more was mentioned about her strange request of the previous day. It was a relief to Sarah not to have to revisit the subject. Instead, they discussed the books she’d read and Sarah was pleased to learn that Alice was managing to concentrate long enough to read and retain the storyline in her head. It was good to have a neutral topic to discuss and there seemed to be a mutual, unspoken, agreement not to bring up the subject of the ‘imagined’ grandchild or Rachel’s visit.
While Alice showered, Sarah made up her bed and changed the water in the bedside jug. She felt that the room would benefit from a few personal items. It was a short-stay room and rather bland in its décor; magnolia walls devoid of any pictures and the pale striped curtains, sun-bleached of their original colour. Most of the residents cheered up their rooms with family photographs or cherished possessions from home displayed on the bare surfaces. Some even brought in their own bedding and curtains of their choosing or even a few pot plants. Sarah, however, wouldn’t be the one to approach Rachel with this idea. If it looked as if Alice’s stay was to be extended, then she’d leave it to one of the staff to suggest such things to her daughter.
Alice was undoubtedly something of an enigma. Her behaviour didn’t quite fit into the pattern exhibited by the others on her floor, many of whom developed ‘magpie tendencies’, regularly taking items that appealed to them. The reservations of their former selves were lost with the illness and their behaviour reverted to being childlike again. Alice, however, generally appeared to be rational, following a conversation or the plot of a book or television programme with comparative ease. At other times, she experienced difficulty with concentration but generally knew where she was and maintained her desire to go home. But her short-term memory was letting her down and Sarah was well aware that if the diagnosis proved to be vascular dementia, gradual deterioration was expected and sadly, there would be no improvement.
Remembering Jack’s words of caution, Sarah mentally warned herself not to become emotionally involved where Alice was concerned.
Later that afternoon, as Sarah approached Alice’s room to offer tea or coffee, Rachel’s voice made Sarah pause, not wishing to see the woman again after the incident of the previous day.
‘No, it’s Friday today, not Thursday.’ Rachel sounded weary as she corrected her mother.
‘Are you sure because we usually have fish for dinner on Friday, but we didn’t today?’
‘Yes, I’m sure.’
Sarah hesitated, then turned back to go into another resident’s room, berating herself for being a coward. But the snatch of conversation she’d overheard troubled her. There was something about Rachel Roberts which made Sarah decidedly uncomfortable.
13
‘Jack, how can I find out if someone is dead or not?’ Sarah’s expression suggested she was serious, but Jack laughed at her question.
‘Take their pulse?’ he joked.
‘No, not like that. I mean in the past, if they died a few years ago.’
He straightened his face to take her seriously. ‘All deaths have to be registered, and I would think you could access that information online. You’ll be better at that than me; you know I’m a dinosaur with technology.’
‘But you must have to do these checks at work?’ she persisted.
‘Yes, but I delegate to someone who knows what they’re doing,’ Jack explained, then smiled at his wife.
‘I’ve already looked at a few websites, but I need the date of death, which I don’t know.’
‘What’s this all about?’ Jack put down his newspaper and looked at Sarah
‘You know Alice, the lady I was telling you about at The Elms? She’s convinced her husband’s not dead, but her daughter told us that he died nearly four years ago. His name’s Tom, so I’ve entered Thomas Roberts, Tom, and every other permutation I can think of, but there are dozens of them, and I don’t have a date of birth or death…’
‘Hang on here. If the daughter says he’s dead, why are you checking up on this? You’re on the dementia ward, aren’t you? Surely this resident only imagines her husband’s still alive?’
‘It’s not just that. Yes, Alice is convinced that he’s alive and there’s something about her daughter I don’t trust, so I’m inclined to believe Alice. And then yesterday, I heard Rachel telling her mother that it was Friday when it was Thursday. So I wondered if she was deliberately confusing Alice to keep her in the home.’
‘That’s quite a fanciful notion. Perhaps the daughter was simply mistaken about the day herself. I sometimes get confused about what day it is, particularly when I’m on a late shift. It’s hardly evidence of deliberate misdirection, is it?’
‘You and your evidence, Jack. Don’t you sometimes have those hunches for which detectives are famous? I just have this feeling that Alice isn’t as demented as we think she is and that her daughter has a hidden agenda.’
‘It can be a dangerous thing to meddle in another family’s affairs, you know. These patients of yours with dementia spin all sorts of yarns, don’t they? Surely the old girl’s just living in the past, or not wanting to face up to the fact that her husband is dead.’
‘I’ve considered that, but I can’t shake off the feeling that there’s nothing much wrong with Alice and her daughter’s deliberately confusing her. Sometimes the medication they’re prescribed can make them even more confused, so what if she is being held against her will? And she’s not an ‘old girl’, as you put it, she’s only fifty-five.’
‘It’s commendable of you to care so much, but I think it’s highly improbable that she’s in The Elms against her will, no matter how much you like this lady and want her to be well again. If you have genuine concerns, perhaps you should speak to your line manager and tell her all this, or does the woman have a social worker? If so, she would be the one to find out more about the family circumstances. It’s not wise for you to go poking about trying to discover these things yourself. You’re only a volunteer there, so leave the diagnosis to the doctors. They know best, and I’m fairly sure they wouldn’t want a newcomer telling them they’ve got it wrong.’
Jack was right, Sarah knew it, but an uneasy feeling about the situation lingered in her mind. Perhaps she’d have a word with Lynne as he suggested. But Sarah couldn’t resist going back to her internet search of registered deaths, trying a combination of different years, months and even the specific area of Matlock where Alice had lived until recently. The search remained fruitless, dare she ask Alice for her husband’s date of birth, or would that disturb the poor woman even more?
* * *
When Monday morning arrived, Sarah was keen to get back to The Elms, her priority being to make an appointment with Lynne, the dementia ward sister, to discuss her concerns. They arranged to meet in the office at lunchtime when Sarah would be having her break and Lynne would have finished her shift.
‘So, what can I do for you?’ Lynne asked, her head tilted to one side and a smile on her lips. She was a great person to talk to, and Sarah would be happy to stay on her ward permanently.
‘It’s about Alice Roberts… I’ve got a few concerns about her.’
‘Ah, yes!’ Lynne gave Sarah a look which suggested that she felt Sarah was becoming too involved with this particular resident – she would get on well with Jack, Sarah thought. ‘No more trouble with her daughter, I hope?’
‘Well, no… except that I overheard her telling Alice it was Friday last week when it was Thursday. I know we all get mixed up with such things at times, but it seemed as if she was deliberately trying to confuse her mother.’
‘Is that all? Don’t you think you’re reading too much into it? Just because Rachel Roberts had a go at you doesn’t mean she’s the Wicked Witch of the West, you know. Relatives often take their frustrations out on the staff, particularly on the dementia ward, it’s a difficult time for them as well as their parent, but it’s all part of the job.’
‘Yes, I know all that, but most of the time, Alice appears to be quite lucid yet regresses after her daughter’s visits. Maybe she does have some memory problems but is she bad enough to be kept here?’
‘Wait a minute, let’s have another look at her notes.’ Lynne tapped on the computer keyboard and brought up Alice’s details.
‘It says here that Rachel is her only relative. Alice still has the DOL order in place, but she’s due for assessment by a Best Interest Assessor this week.’
‘What exactly will they do?’ Sarah asked.
‘They’ll chat with Alice and ask her a few questions and then make a decision about whether she has the mental capacity to make her own decisions. The assessor will then consult with the doctor, and if they feel Alice is capable of making her own choices, they’ll ask her what she wants to do.’
‘I’m certain the answer to that particular question will be that Alice wants to go home. Can her daughter reverse any decisions the doctor makes?’
‘If she has power of attorney, she’ll have some input into the decision, but there’s nothing on Alice’s notes to say her daughter has POA.’
‘What if Alice still maintains that her husband is alive, and now there’s this imaginary granddaughter too? Will that prevent her from going home?’ Sarah could see this as a possible stumbling block.
‘Not necessarily. We’ve had patients before who think that their partner’s still alive yet have been deemed safe to live alone. Very often, their delusions are a comfort to them. Being confused doesn’t automatically mean that someone has to go into care, and sadly the money aspect also comes into play. More and more people need places in care homes, and there just isn’t the money available to fund them, so, in reality, only the very worst cases will get a funded place. Perhaps Alice’s circumstances are such that she could fund a place privately, but from what we know, that’s certainly not what she wants.’ Lynne looked at the concerned expression on Sarah’s face.
‘Look, don’t get too involved in this, okay? Our residents are transient for one reason or another, and this is a tough ward to work on. You can’t afford to become emotionally involved with them all. You need to be a few degrees detached for your own sanity. Believe me, I know!’
‘You’re right. Thank you for explaining everything, Lynne. Can I tell Alice that this assessment is coming up?
‘Of course, it’s not a secret, and she has a right to be informed, but choose your moment carefully, won’t you?’
‘You mean when her daughter’s not with her?’ Sarah grinned. ‘Now, I’d better grab a sandwich before I get back to work. Enjoy your afternoon off.’ Sarah was heartened by what she’d learned. It appeared to be a possibility that Alice could go home after all. Sarah knew that this piece of news would cheer her up immensely.
14
Sunshine streamed through the window of Alice’s room, warming her cold flesh. She allowed her eyes to close, willing the time to pass swiftly, and her thoughts drifted back to long ago. Living in the present was difficult, but she’d experienced worse in the past.
Alice 1996/97
I closed Matlock Coffee & Cake immediately after the accident, unsure if I would ever be able to continue the venture without Karen. The physical act of opening the door and stepping inside the premises on that first occasion after the accident was even worse than I anticipated it would be. My sister’s ever-present laughter was gone, replaced by a heavy silence, an almost viscous atmosphere that had nothing to do with the hot weather and tightly shuttered windows. Karen’s apron and cap hung behind the door in the kitchen as if waiting for her to return to work and slip them on again. The sight of them stung the back of my eyes and weakened my already trembling legs.
Dust motes filled the silent void, their dance almost mocking. Every item in the room held a bitter-sweet memory. Karen’s jar of wooden utensils, the huge copper pans hanging from the ceiling rack, the blue and white pottery stacked neatly on the gleaming stainless-steel shelves. Everything so carefully chosen and loved by my sister.
Being in the place of our shared dream proved to be far too painful for me – the life and laughter had been sucked out of the place, and I could barely bring myself to look for the papers I’d gone there to pick up. It took only that one visit to know that I couldn’t carry on. I’d hoped that feeling Karen’s presence in that special place we’d worked so hard to create would bring comfort, but it held only raw memories, ones with which I couldn’t cope, and I knew it was the end of our dream.
A couple of months after the cafe closed, I received an offer to buy the business and snatched at the opportunity. My enthusiasm had waned so much and I could no longer cope with the daily reminder of my sister’s absence and everything we’d lost. The decision also gave me more time to devote to Rachel and my failing parents.
Tom and I couldn’t read our elder daughter at all. She hadn’t shed a single tear in the weeks since the accident, at least none that we knew of, and reverted to that small, lost child she’d been before Jenny’s birth. I longed to hold her close and comfort her, to stroke her hair and kiss away the hurt, but she shrugged off any physical contact we offered, resisting all attempts at consolation.
After a few weeks, we sought help from our doctor, who advised us to give Rachel more time and space, reminding us again that the counselling route was still available.
The first year is always the hardest. I heard it from so many well-wishers, and in many ways, it proved to be true. Anniversaries were to be faced, birthdays, Christmas, and so many other meaningful dates that the first year was an arduous one. Places we’d visited as a family became no-go areas; the memories they stirred too painful.
My mother’s health started to deteriorate, and almost before my eyes, she turned from being a strong, independent woman into an old lady, well before her time. The loss of her daughter, son-in-law and two grandchildren was almost too much for her to bear, and she developed illnesses, which, although not definitively connected to the grief, were undoubtedly compounded by the stress she’d suffered. Doctors diagnosed angina on top of depression and my mother declined rapidly, both physically and mentally. She lost weight at an alarming rate and became reclusive, refusing to leave the house despite our efforts.
Naturally, this profoundly affected my father, who assumed he was somehow failing his wife and couldn’t be persuaded otherwise. Dad took over caring for Mum, a woman who had always prided herself on being capable and in control, the one to cater for family celebrations with such ease and lightness of spirit. Tom and I could see the changes in them both but were incapable of reversing their decline, even though we tried everything which came to mind. During that first year, I pushed my grief aside to help my surviving family, but, like my father, I too felt powerless to alter the situation.
Rachel, however, remained our chief concern. While Tom found some escape at work, I stayed at home in an attempt to make a good life for my husband and daughter. I cleaned the house frantically, often unnecessarily, to fill the long empty hours and baked more cakes than we could possibly eat. We encouraged Rachel to take an interest in things outside of school, sports or dancing classes, riding lessons, perhaps? We offered her everything we could think of to enhance her life but found nothing for which she showed even the slightest enthusiasm. Of course, the one thing she wanted was to have her sister back. It was the same for us all – but it was never going to happen.
After school, Rachel would go to her room to do her homework without a word unless I addressed her directly with an open-ended question. I began to wonder if she blamed me for Jenny’s death, for letting her go with Karen and James that fateful day, or was it me blaming myself? If only I’d kept her at home with Rachel. How many times had I wished that was the case?
On the positive side, Rachel excelled at school, academically at least. She proved to be a very bright, capable student, and when the time came to move on to secondary education, she was easily at the top of her class, with her teachers singing her praises at every opportunity. Our daughter’s head was always in a book, whether homework or a novel, a good habit, but I often wondered if she was hiding between those pages, hiding from Tom and me, or even from herself.
A year after the first aborted attempt at counselling, we decided to pick up the sessions again for our daughter, yet once more without success. Rachel refused to engage with the counsellor and even going to the sessions became a contentious issue, so we finally abandoned it.
Was it even right to try to make Rachel talk about her feelings? Could she be dealing with the loss in her own silent way? There were so many questions and, quite simply, no answers. Yes, we still talked about Jenny, I couldn’t bear to erase her from our lives as if she’d never lived, but we tried to be sensitive and not overdo it, for Rachel’s sake, yet she rarely participated in any such conversations. Looking back, I can’t ever remember her speaking her sister’s name after the accident. She remained almost cold, aloof, and there appeared to be no way to reach her, no matter how hard we tried or how innovative the ideas we came up with.
Another problem presented itself for us as far as Rachel was concerned. We had not told our daughter that she was adopted. Somehow the time was never right, and now, when she was on the verge of going to senior school, we felt she had a right to know. But having lost her sister, we struggled to decide if this revelation would be another significant hurdle to overcome. Would it perhaps be too much for our daughter to bear, and possibly even the final straw?
Tom and I spent many evenings discussing this issue; should we, shouldn’t we? It was at times like this that I missed my sister, Karen. She was so wise in such matters and would have advised me what to do. I could no longer turn to my parents for advice, as they struggled daily with their own problems, and I didn’t want to add to their burdens. Eventually, we took the easiest route and procrastinated, yet again.
