Background: Nurse arrives early to administer Aricept. Mum won't let her in, and dad is already off down the road to Day Care. Nurse returns later when careworker is present. [Big Mistake]

Scene: Nurse attempts pill enforcement. Patient refuses. Nurse attempts pill enforcement. Patient strikes nurse, careworker and attempts to bite them.

Response: Nurse calls me to say the service must now be cancelled.

I'm livid. I sympathise with the nurse, who was probably frightened at mum's ferocity, but I know we cannot blame mum entirely for this incident. My standing instructions, which have usually been cavalierly disregarded, are:

  • visit in the afternoon, not the morning
  • offer the pill, do not insist
  • at the first sign of refusal, give up
Our nurse, to whom I have stressed these points several times, does not comply. I am at a loss to explain why. A stupid person might have trouble complying, an arrogant one might. I do not know her reason. This kind of thing drives me to the point of wanting to shout down the phone. But I restrained myself; I merely made my points forcefully today.

the nurse's underlying message is that it is never her fault:

'We have a duty to administer the medicine.'
'We know what we are doing.'
'I do as you say.'
'We cannot work under these conditions.'

She tells me to call her supervisor. When I do I get the 'customer service' facade with little convincing sincerity underlying it. I tell her I am furious, I'm particularly exasperated at the way my instructions are disregarded.

'Neither of us was there so we can't say your instructions were not followed,' she tries.
'We can say most definitely that they were not followed, since the nurse returned to the house after my mother had initially refused.'
'We have a responsibility to ensure that the medicine is administered.'

Yes, I think, we have to make sure the chemicals go inside the organism, for its own good. Its behaviour is only of concern when it threatens our staff. We do not consider ourselves a threat to the organism.

We go round and round in circles. My message is 'follow the instructions, avoid trouble'. Hers is 'we give medicine when it is safe for us to do so.' I try to make the point that there is a way through here, but it requires careful steering on the nurse's part. In the end the supervisor says she will keep the service going for a week, with strict 'adherence' to my instructions, but at the first sign of violence the service will be terminated. I know this is just being set up to show I am wrong. There is no chance of them continuing with it.

'What about my dad?' I ask.
'We can continue to give him his medicine, perhaps at the door,' she says.
'And could you not at the same time offer my mother her pill?'
'We can offer.'
'So what is the problem?'
'I cannot send my nurses into situations where they may be caused harm.'

Arghh! My brain is ready to explode. I am torn between trying to remain diplomatically persuasive and screaming and swearing (just like mum). However, as I've expressed my feelings already, I end by agreeing to the week of careful 'adherence' to the instructions.

Yet another social service that looks fine on paper but just doesn't cut it in the real world.

PS: Regan called later to say that she had had a call from the nurse when events were at their most heated and heard how she was talking to my mother. Regan was completely unimpressed by the way the nurse spoke to mum. And what was she doing making a call on mum's phone when mum was trying to get her out of her house?