This 40 year old memory has surfaced vividly for me since the coronavirus hit us, perhaps because the elderly, of whom some people would say I’m one (I’m 69) have been in the news, because we’re (they’re?) at great risk, or need to be sacrificed for herd immunity. I’m not sure which.
I’ll start with a little background. It took me a year or two of mind numbingly boring work and study to realise at the age of 27 that a career in accountancy just wasn’t for me. I moved into social work, which suited me much better. After spells as a care assistant, usually the only male member of staff, I quite quickly got a job as a Deputy Officer In Charge (it meant Assistant Manager) of a home for elderly people in the north west of England. I enjoyed it a lot, even though my boss wasn’t the most encouraging. I think she was dubious about men doing caring work. I was good with figures though, so she immediately shoved all the paperwork, bills etc, on to me, including the ordering of food. I remember every week buying some lovely cuts of beef that I never seemed to see on the residents’ plates. Perhaps I was there on the wrong days.
Like most elderly person’s homes (they weren’t called care homes in those days), we had our fair share of residents with dementia – agitated, often angry old people, mostly ladies, who spent their days wandering around the home lost and confused, occasionally asking for their mum, or berating us for some imagined wrong. But even those ladies could usually be reassured, even entertained, with a smile, some tea and a sing song. Just our company would do the trick really.
The residents with physical problems were able to enjoy relatively fulfilling lives, since we could help them get around, make sure they got a bath when they wanted one and provide a decent meal, even if the meat was from the cheap end of the cow.
One of our residents, I’ll call her Elsie, celebrated her 109th birthday while I worked there. I’m not going to say Elsie was the oldest person in England at the time, because I seem to recall there was some competition for that title, but she was certainly in one of the medal positions. She was tiny, a featherweight, frail, quite confused and usually smiling, when she wasn’t asleep, which was a lot of the time. Everybody loved Elsie and it seemed she loved us, despite not knowing who we were. She was of course famous. Every visitor said hello to her and shook her hand if she was awake, she herself having no living relatives as far as I knew.
My boss, I’ll call her Margaret, decided that Elsie must have a party for her 109th birthday. Elsie didn’t disagree, not being asked, which was probably fair enough as she wouldn’t have understood what was being offered. Anybody who was anybody in our little town was invited to the shindig, from the local MP down to the postman. There was bunting and sandwiches and cake and jelly and even some sherry. Elsie enjoyed the party immensely before she fell asleep, and she was even persuaded to perform her party trick, which was to sing a song from the First World War. I’ve forgotten what the song was, but I remember that Elsie’s small, squeaky voice made her sound like a little bird, like the wren that I often see scuttling around the grounds of my apartment block. One of the precious few positives of lockdown is the sound of garden birds that is so clear now. Wrens have an amazingly powerful song for such a tiny bird.
A few weeks after her celebration, Elsie’s health started to deteriorate. After an examination the doctor told us that her heart was failing (that’s Elsie’s heart, not the doctor’s). There was nothing that could be done, he said, other than keeping her comfortable and hydrated.
After a week or so, it became clear that our little bird had no more than a few days left. She slept almost continuously, couldn’t take much food and her breathing was laboured, inconsistent and noisy. ‘Cheyne Stokes’ breathing apparently it’s called, although, in those pre-internet days and me knowing next to nothing about nursing, I thought whoever told me had said it was ‘chain stoke’. It was a breathing I became familiar with over the three years I worked with the elderly, as it indicated terminal heart failure. Exhalations are loud and grating (like a heavy chain being dragged, hence me misspelling it), whilst inhalations are short and ineffective. After a few of these the breathing suddenly stops altogether, so that you fear that the person’s died, before the cycle abruptly restarts with a big, gasping intake of air.
My boss told me that if I was on a sleep-in (where you sleep on the premises to be available for emergencies) and it seemed that Elsie was unlikely to live through that night, I should phone her at home and she would come out to be with Elsie at the end. As bad luck would have it, I was on duty when that night arrived. By the time all the other residents were in bed, I could see and hear that Elsie’s breathing was much worse and that her death probably wasn’t far away. I asked the two waking night staff to look after everyone else and said I’d sit with Elsie for as long as necessary. I wasn’t sure if or when to phone Margaret, as for all I knew Elsie might hang on until the morning, and I didn’t want to bring my grumpy boss in unnecessarily.
By about 1am I felt pretty sure that this was the night. It was our practice to turn bed bound residents frequently to prevent bedsores and as I and one of the care assistants were doing that, I saw that the veins in Elsie’s feet and ankles had gone dark. That meant they weren’t getting any blood flow. That’s what happens in the final stages of heart failure. The heart simply isn’t strong enough to pump blood any more and the extremities suffer first.
There were no signs that Elsie was in any pain or distress. She just seemed to be in a deep sleep, even with the awkward breathing. She was unconscious I guess. I phoned Margaret so that she could come in and she sleepily said she would. I returned to Elsie’s room and sat holding her hand, waiting.
Margaret’s house wasn’t far from the home, so it wouldn’t have taken her long to get to us. She didn’t arrive though. At 3am I saw that Elsie’s legs were now dark and I reasoned that at that rate after another hour or so she would probably die. Still no sign of Margaret. I assumed she must have fallen back to sleep. I decided not to phone again, in case I got into trouble for waking her twice.
At 4am or thereabouts, with me still holding her hand, Elsie died, quietly and unfussily, as was her style. Her breathing just stopped, and didn’t start again. I had seen people die before (I remember one old chap explosively evacuating his bowels at the moment of death – thankfully I was on the other side of the room at the time), and it’s always a chastening experience, even for an atheist like me. I sat in silence for a few minutes, as it always seem the right thing to do, even though I don’t think there’s a soul in there packing its bags and moving on. Knowing me, I was probably trying to calculate how many breaths Elsie had taken over the course of her 109 years and a bit.
I let the other staff know that Elsie had gone and then phoned the doctor, as only a doctor can confirm death. He said he’d come out immediately, but, like my boss, didn’t. I phoned Margaret again, to give her the sad news. She quite reasonably said there was no point getting up then and that she’d be there first thing in the morning.
You’re not supposed to do anything to a body until the doctor confirms that death has taken place, but after about 45 minutes we knew that if we didn’t rearrange Elsie’s limbs soon, rigor mortis would set in and her legs might get broken when she finally was straightened. I can’t remember if I phoned the doctor again, but if I did he still didn’t turn up. The night care assistant and I laid Elsie out straight, washed her hands and face and brushed what hair she still had. She was then clean and tidy and ready for the undertaker.
Margaret arrived at 8 and paid her respects. She apologised for not making it before the end. The doctor turned up at 10, confessing that he’d fallen back to sleep earlier. He examined Elsie, who was now of course cold, grey and stiff. “I think she’s dead”, he said, sheepishly. “Yes”, I said, deferentially, “I think she is”. Time of death, 10.10am.
The undertaker arrived later and took Elsie away. I don’t remember the funeral. I was probably on duty, since Margaret would have been there and one of us had to be in charge at the home.
The day Elsie died I was on a double shift, which means I was working through until 10pm. That was usually fine, so long as you’d slept the night before, but I hadn’t of course. By the time I went off duty and to bed, officially at 10, but it was always later than that, I’d been continuously awake for more than 36 hours. I was so tired I was almost hallucinating and had very little idea what I was doing. Thankfully, nobody took sick or died that night.
I don’t know how many elderly people have died, and are still to die, during this pandemic, here in the UK and across the world. Tens of thousands I suppose. I never knew what Elsie had done with the 108 plus years she lived before I met her. I wish I had. Her life mattered, whatever she did with it. Every life, and every death, matters.