What would you like for christmas? I ask 93-year-old Winnie at the end of my daily morning visit. 'just a bit of company', she replies with a somewhat sad smile.
Being this gentle woman's carer for nearly a year, I have come to love her dearly. I like her sharp mind and endearing old school English humility.
I arrived just after 7 this morning and a heavy stench hit me as I entered her flat. Winnie had diarrhea and has spent two futile hours trying to clean herself up.
'I'm afraid I had diarrhea' she tells me ashamedly, like a potty training child who just had an accident. 'Don't worry', I say as I comfort her.. 'we'll soon clean you up'.
I open up a few windows to air the place, I quickly let my next client know I am running late, fetch her walking frame and slowly lead her to the bathroom. She cannot step into the bath and considering the two hours that have passed since her accident, I can tell today's strip wash is not going to be easy.
With cotton wool and running warm water, I gently clean her near skeletal body. The frail woman's pride is bruised and all throughout the long washing process she apologizes for 'the mess she's made'
'This is what I'm here for' I tell her, searching for ways to take her mind off the distressing situation. Stories of my little boy announcing this morning that he has cancelled Christmas put a faint smile on her face and I get specially nice clothes from the wardrobe for her. I scrub the carpet but phone the building warden to say an industrial clean might be needed.
I change her bed sheets and rush to get her breakfast ready. I tidy up, leave snacks out by her tv chair, a glass of water and a reminder to drink water and take her morning medicine.
As I leave she tells me she had a milder diarrhea episode over the weekend and that 'the foreign weekend carer couldn't understand her'.
Nearly half an hour late for my next client and with a heavy heart I leave Winnie by her breakfast table, walking frame nearby. My promise to pop in on the way back from school with my little ones cheers her up no end. Winnie never had children and whenever she plays with mine I can't help thinking what a smashing mum she would have made.
I enter Erik's flat and a friendly 'good morning' greets me as I open the door. The homebound 88 year old is awake, sitting in bed.
'Good morning Erik' I say with a smile, 'have you been up long?'
'I woke up 6am and couldn't go back to sleep' he tells me, politely asking me to put the kettle on.
As he drinks his tea I start getting him dressed. The worst part is the painstaking task of putting the tight surgical stockings on his swollen feet. 'Two logs' he calls his legs, half jokingly as he can hardly feel them and moves around in his wheel chair.
I help him wash and as with all my elderly clients, engage in light conversation, keeping a cheerful tone throughout.
I prepare his 'double helping' of porridge and while he eats, I tidy up and clean the flat. By the time I get him dressed, cook his breakfast, sort out his laundry, see to his morning medicine, fill his recycling bins and leave them out ready for the weekly refuse collection my time is up.
I help him to the toilet before I go and leave him sitting comfortably on his tv chair as I rush to Enid's house.
The 92-year-old can just about walk using a walking frame but due to poor eyesight, needs help with even the simplest of tasks. She enjoys her daily strip wash and as I gently dry her up she asks me to rub her back. 'Ooohh that feels nice' she says with pleasure. As she cannot use the sink, I place a towel and a big plastic bowl over her lap. I hand her a tooth brush and stand by with a glass of water. She brushes her very few teeth and rinses her mouth, spitting into the bowl. I get her dressed, genuinely complementing her exquisite fashion sense and insist she walk with her frame to the sitting room however long it takes. 'I know its not easy but this light exercise is good for you' I say encouragingly as she staggers to her chair.
While she eats her breakfast I clean up the bathroom, dispose of a bag full of dirty sanitary pads and take her domestic rubbish out. I leave a few snacks for her by the TV chair where she spends her day.
Enid resents her enforced solitude and always 'finds things' for you to do as you leave. I was rightly told by the agency to keep a closer eye on the clock as I tend to leave late but I must admit that the sight of her solitary, painfully thin self sat by the breakfast table, breaks my heart.
My next visit is to Paul who suffers from dizzy spells and needs help taking a shower. He holds on to the safety rail as I wash him. By the time we get him dressed my half hour is gone. He asks me to check his hearing aid and I end up changing the batteries.
This is a short day and my last visit is to a lady I don't often see. Her tiny body reminds me of the 'shrinking mother character' in Garcia Marquez's One Hundred Years of Solitude. I get her lunch ready and start cleaning up when I notice that her bed is wet, her pad must have slipped during the night. It takes me forever to find out where her clean sheets are. I give the dirty sheets a thorough rinse and leave a note for the lunchtime carer to say there is a load waiting to go in the washing machine.
I collect little ones from school and we stop by Winnie's house on the way, as promised. Her face lights up when she sees the children. My boy bakes her imaginary cakes and draws a picture of 'Winnie when she was a little girl'..she loves it.
Like nurses, carers' work is physically and emotionally demanding. Days are full of trying situations and it is easy to fall behind. Genuine compassion is a wonderful quality for a nurse or carer but is a bonus, not the reason for performing your duties well. A less compassionate carer might not check on a patient out of hours or stay overtime without expecting extra pay but with clear guidelines and ongoing supervision, he/she will leave a client clean, fed and reassured.
What nurses/carers need are clear guidelines and constructive supervision. My job is clearly defined by specific tasks which must be completed before I leave a patient and yes, respecting the client's dignity is one of them.
A nurse not checking on a patient for hours on end is not doing her/his job properly, not offering patient's worried relatives a cup of tea, hours after they arrive in the hospital is bad manners and a carer who cannot speak English should consider a different line of work.
Encouraging compassion is a positive step but it employers need to make sure workers are doing what they are paid to do and that they, as well as people higher up are held accountable for their actions.
(All names have been changed)