Grandma’s white hair kept moving around, obstructing my view of the TV. We were watching Sir David Attenborough’s latest spectacular wildlife documentary on a Sunday evening. Grandma was very close to the TV, due to her poor eyesight and I was much further back at a ‘normal’ distance in the opposite corner of the room. She never usually blocked my view or moved around this much. My carer Spidey-senses were activated and I knew something was wrong but she was hiding it. I sighed and got ready for the questioning and denials that I knew would follow. 

‘Grandma, what’s wrong? You’re shifting around a lot. I can’t see anything.’

‘No, I’m not!’ She said, obviously lying.

OK– I thought to myself- strong initial denial means something is definitely up.

‘Grandma, I can see you moving!’ I said.
‘Well, I’m just crossing my legs!’ She answered, immediately trying to slowly cross her legs.

‘Please stop lying, what’s wrong? Is it the cushion? Does it need re-adjusting?’’ I insisted.

‘No, nothing is wrong.’ She insisted back. 

She’s lying, I thought, I’ll try again in a few minutes and catch her off guard.

As we watched in silence, Grandma’s head was tilting more and more into my view, like she was trying to see something across the room. Her discomfort was obvious. 

‘Right. I know you’re lying! You’re practically leaning off your chair. What’s wrong? Are you in pain?’ I asked again, getting up. Me standing up always created pressure for her as I walked over to her. 

Still heavily leaning to one side; she insisted nothing was wrong. She looked at me faking wide-eyed innocence.

‘Come on, stop lying. What’s wrong? I’m sure we can sort it out.’ I said softly.

Her face betrayed her, frowning in pain as she moved in her chair.

‘Does sitting hurt?’I asked.

‘Well… yes… I don’t know why…’ She finally conceded.
‘Ok, let’s have a look.’ I said as I prepared to help her up. I was careful to keep my tone light and neutral as whatever was hurting might be in a delicate area. She got up with a groan and I helped her go into the bathroom. She was still weak from a recent bad chest infection.

‘Right, grandma, will you let me have a look? Where does it hurt?’

‘When…I sit down.’ She said, sounding embarrassed.

‘On your bum?’ I asked delicately.

‘Y…yes…’ She said with a sigh.

‘Let me have a look.’ I said quietly as I lifted her skirt up. A tense, embarrassed silence fell between us. I’d done a lot of intimate care during her various illnesses when she was too sick to be bothered about it. This was different, she was embarrassed and in pain. I was gentle in my examination and, in a very intimate area, I found the source of the pain. It was a big red, angry-looking pustule. Before I could say anything, Grandma asked: ‘It is haemorrhoids?’

‘I don’t know, I’ll have to do some research. I’ll put some hydrating cream on it, see if that soothes it for a bit.’

‘NOOOO! Don’t touch it!’

Ready for that reaction I calmly replied that I would be gentle. I put a few more cushions on her chair and she flinched as she sat back down. ‘I’ll call the doctor in the morning.’

‘That lot won’t know, you won’t even be able to speak to anyone.’ She said in a huff.

‘Then I’ll go to the pharmacy. We can’t leave it. How long has it been like that?’

‘A few days…’ She said looking down.
‘Grandma, please tell me this stuff! If I don’t know, I can’t fix it.’ I said for the umpteenth time. 

‘I dooooo tell you!’ She answered, in her usual high pitched tone she used when she was lying. 

I got up extra early the next morning to make sure I was ready to call the GP surgery and have the usual passive aggressive fight with the receptionist to get any sort of medical attention. After 43 minutes on hold, I was summarily dismissed as ‘non-urgent’ and couldn’t even book a 10 minute call with the on-duty nurse. Determined to get some help, I went to the local pharmacy. I had to attend a conference call at the same time but grandma’s discomfort couldn’t wait. As I waited my turn in the queue, I double-checked I was muted on the call before explaining the delicate problem. The pharmacist was her usual helpful self, in no small part due to her thinking my accent was ‘so regal’ ( I have not yet developed a Lancashire twang). She suggested it could be a pressure sore, which also seemed to be the conclusion I had come to from my online research. My grandma had been sat a lot more as she had recently been ill. She sold me a barrier cream to apply twice a day and gave me the number of the local district nurse’s office to see if they could help. I thanked her in my best impression of someone vaguely royal and hurried home. 

It took me 5 tries over 2 days to the District nurse’s office who said they would come round to help treat the sore. I told them to please not come on Tuesday or Wednesday mornings as the patient would be out. I was told that they’d come when they could, I said I understood they were busy but coming when the patient was out, seemed less than ideal. In the meantime, I continued to apply the barrier cream twice a day and made sure grandma had plenty of cushions.

The following Tuesday morning, as I was in the middle of writing a report, the doorbell rang. It was one of the district nurses coming to see about ‘a patient with haemorrhoids’. I politely told her it was in fact a pressure sore and that the patient wasn’t in; she was shopping with her carer, as I said on the phone last week.

‘Riiiiiiiight.’ Was the frosty response. Ignoring the tone, I asked if they could help with a pressure cushion as I’d read online it could help. The nurse said she’d need to see the patient before giving anything; and that I really should have given times the patient wouldn’t be in. I politely repeated that I had already done that.

‘Riiiiiiiight.’ Was the answer as she turned around and walked back to her car.

Exactly a week later, the doorbell rang. I answered to find another district nurse enquiring about ‘a patient with haemorrhoids’. I laughed as I politely informed the nurse that it was a pressure sore and that I’d told the office and the nurse that came last week that the patient wouldn’t be in on Tuesday or Wednesday mornings. I suggested she might like to make a note of it to stop wasting their time. I asked again about a pressure cushion, thinking I might as well try my luck, and to my surprise, she went to check in her car and pulled out a black pressure cushion that we could have. Success! As long as I did the actual nursing, the system would eventually provide a pressure cushion.

I didn’t see another nurse for months, although grandma insists one came over a third time and took a photo of the pressure soar: ‘I’ve never had anyone take a photo of my bottom before!’. I can’t remember that, I must’ve blocked it from my mind. Regardless, I continued to treat the sore twice a day, and as it slowly healed up, my grandma stopped leaning to one side in her chair.

Months later, one Friday morning, as I was making my cup of mid-morning coffee, the doorbell rang. I answered the door to come face to face with the first district nurse. 

‘Oh hello!’ I said surprised.

‘I’m here to see a patient with haemorrhoids. Can I come in?’ She said, walking into the house. 

‘Yes, it was a pressure sore and that’s all resolved now.’ I said, showing her into the living room.

‘Grandma, a district nurse has come to see you.’ 

‘What? Why?’ She said, sounding immediately worried.
‘I’m here to check your ​​haemorrhoids.’ The nurse said in a cheerful tone. 

‘Haemorrhoids! I don’t have haemorrhoids!’ Said grandma indignantly.

‘As I said, she did have a pressure sore months ago but it is resolved now.’ I explained calmly.

Taking no notice of me, the nurse turned to grandma and said: ‘Right, is there somewhere we can go to check your bottom?’

‘I…yes…I supposed so.’ Said my grandma, sounding baffled and scared.

I smiled to myself, finding this all quite amusing. Perhaps the nurse had to check for herself and not believe the carer. A few minutes later, they both walked back into the living room, the nurse saying: ‘There’s nothing there!’

‘No, we told you. Hasn’t been for months.’ Said my grandma still baffled. ‘Your colleague gave me this cushion to sit on. Didn’t they tell you?’ She said, pointing to the black cushion on her chair.

‘Did we give you that?’ 

‘Well, yes!’ Said grandma confused.

‘They’re very good those, good for prevention. We’ll need it back.’ She said, taking the cushion from the chair. 

‘Really?!’ I said quickly ‘But if it is good for prevention…’

‘Our aim is to close cases, and this case is closed.’ She said smiling to grandma.

It took all my willpower to not say that the case had barely opened. They’d come twice over 2 weeks at the wrong time for a condition that required treatment twice a day, for months. The only bit of this ‘case’ they helped in was giving us a pressure cushion to prevent the issue recurring, and were now taking it away. Besides, shouldn’t their aim be to care for patients and not to ‘close cases’?! Instead, I reassured grandma  that I would buy a pressure cushion online. After the nurse left, grandma looked completely bemused.

‘How peculiar! They didn’t come when I needed it, it wasn’t haemorrhoids, and she insisted on checking my arse when there was no need! And she took my cushion!’ she added as an afterthought.

I burst out laughing at her spot-on summary of events as I looked up pressure cushions online. 

I’m sure the nurses were doing the best they could but the system and organisation within which they operate is terrible. My grandma would never have recovered had I not been there to administer the care, and insisted she got some medical attention. Elderly care is nearly non-existent in the UK and the NHS is utterly incapable of providing any kind of sustained care. The lack of proper organisation exacerbates the issue and wastes already-pressured resources. A bit more coordination would help the nurses focus on the correct patients and administer the required care- with less unnecessary arse checking.