by Catherine Caulfield
It was common in my days as a nurse in London, to care for elderly men and women who lived alone. I worked on a ward specialising in Orthopaedics and Trauma, which meant that we received patients who had fallen and sustained broken bones. The area surrounding the hospital was quite socially deprived. As a result, our admissions where primarily those suffering with mental health issues and addiction; who had suffered an injury or accident.
One of the cases I remember extremely well was of an elderly man. He was an alcoholic and lived alone. He had fallen and broken his hip. For the purpose of this story, I will name this patient James.
The story of James
James was very agitated, physically and verbally abusive – a common side effect of withdrawal from alcohol. It would usually take a few days and sometimes weeks for withdrawal and detox to come full circle. But, as a result of prolonged alcohol and drug use, James continued to behave with agitation even after “drying out”.
I’ve seen this happen many times, as the person’s brain and liver has suffered the physical consequences of long periods of poisoning.
James had surgery to correct the injury on his hip, and as expected was even more agitated as a result of the anaesthesia, medications, pain relief and immobility. He was very difficult to care for and make comfortable, especially at night and even more so when a full moon came around! There’s a reason the word “lunatic” comes from the moon (Luna).
He would climb over the railings of the bed, which were in place to protect him from falling. He shouted abuse to the patients beside him, and could be very distressing for many experiencing their own illnesses and injuries.
How a „tough guy“ defies his environment
James kicked, punched, hit out; despite us talking to him kindly, explaining and communicating to him with care. There was a mean streak in James’ eyes, a glint of mischief; like he knew he was causing trouble and he liked it. It was clear he had grown to be hard around the edges. Maybe it was his way of looking for attention. Unfortunately, he soon lost the patience and trust of everyone!
It took longer than usual for James to heal after surgery, but eventually, when it was safe to do so; we moved him from the bed, onto a mattress on the floor to lessen the impact of his spontaneous movements. This was to reduce the possibility of him hurting himself again.
A week or two later, after working on nights with James, I was exhausted mentally, emotionally and physically. I went home after my final night and started thinking about how I could meet him at his level and break his pattern of destruction!
„We’re going to have fun today James.“
A few days later, renewed with energy, I decided what I was going to do. I bounced onto the ward early in the morning, to be met with the mischievous gaze of James sitting up on his mattress on the floor. He gave me his crooked smile. As frustrating as he was, his spirit made me laugh.
Smiling, I gave him a wink, saying “we’re going to have fun today James”. He didn’t know what I had planned, and I was excited to get started. Luckily that morning we were over staffed, which allowed me some uninterrupted time with James. So, once breakfast was over I gathered everything I needed. Today, James was going to receive a make over!
I already expected some resistance from James, so that wasn’t a surprise. After a while James began to settle and I think as we had spent a lot of time together already, he trusted me. I was also the only one able to communicate with him using his own rogue wit, which made him laugh and this made everything easier. My Irish humour really helped a lot during these difficult situations with James!
That morning in the shower, James got a hair cut, a clean shave, finger and toe nails were clipped, skin moisturised, ear and nasal hair trimmed. Scrubbed and buffed, he emerged from the shower wearing fresh new pyjamas and slippers. I took James to the mirror to have a look at himself. He beamed! … smiling from ear to ear, looking at me and then laughing.
Like new born!
As I wheeled him back onto the main ward, all the nurses and health care assistants cheered with compliments and smiles. James just smiled and smiled. He was energised, renewed, lighter and fresh. After helping him to sit, we brought him a cup of tea. And I watched with contentment that this man was now in this moment, comfortable in his own skin. He had left some of the past in the shower that morning. The warm soapy water, care, attention and nurture had helped him discover what lay beneath.
I do believe that he saw himself in the mirror that morning, for the first time in many years.
We weren’t sad to see James depart when his time came to go home. We were happy to see him leave moving better, eating better, communicating better and taking an interest in himself. He had changed us, and in the process changed himself.
Loving care can make a lasting difference.
I had a softness for James in my heart. I knew many older men like this in my youth. They were funny, challenging and interesting characters. My mother always took them in for tea and jam sandwiches, and usually had a new jumper or pair of shoes for them to wear. She was a psychiatric nurse so had a kindness for these men who were alone and isolated, and trying to get through life day to day.
Several months later, by chance, I saw James again. As I walked back to the ward after a tea break, I noticed up ahead on the corridor, the frame of a man I thought I recognised. He was in the distance. The morning light was streaming in and it was hard to see. But then I saw James, and then he saw me.
I smile now thinking of that moment. Both of us smiling at each other. James looked healthy. He was shaved, dressed in clean clothes, bright eyed and using his walking stick. More than that, he was actually coming back to attend a follow up appointment about his hip, which he could have easily decided to ignore!
We hugged and chatted for a few minutes, and then James continued his journey in the world.
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