There are some patients who you never forget. The three years she spent working with The Roses* will always be remembered by community nurse Sue McCready.
The cottage looked as if it was part of the mountain. It sloped slightly to the left and the front door was partially obscured by trailing ivy. A stream rippled behind it. I had been told to come after 4pm as the Roses were never up until then. I knocked on the door and a cacophony of barks assaulted me with a scurry of claws on stone.
After a wait of 10 minutes spent calling through letterbox I heard a movement behind the door and a voice: “Who is it? What do you want?!”
“It’s the nurse, Mrs Rose. I’ve come to dress your husband’s leg.”
Silence. And then eventually after several unboltings the door opened a crack and a tiny dishevelled woman looked up at me. “He’s just got up. ”You can come in but don’t touch my babies.”
“Eventually after several unboltings the door opened a crack and a tiny dishevelled woman looked up at me”
I stepped inside into blackness, a faint light from the back of the room looked as if it might be the kitchen. A large ambling furry thing nudged my hand and as my eyes became accustomed to the shadows I saw I was surrounded by Irish wolfhounds who came up to my waist. I started to walk forward and a swarm of movement stopped my feet.
“Mind the babies!” Mrs Rose shouted and I looked down to see a mass of movement from what seemed to be many wriggling brown dogs of indiscriminate breed.
“How many dogs do you have here, Mrs Rose?” I asked, sliding my feet forward into the gloom.
“14. Five wolfhounds and the rest dachshunds. Just you be careful you don’t hurt them!”
She was fierce for someone so tiny and I needed to keep her sweet as it had taken me a month to get past the door. The Roses were reclusive and resented any interference from ‘authority’.
She led me to the centre of the room where there was a rocking chair and a stove burning wet wood filling the cottage with smoke. The place was filthy and as I got nearer to the light from the kitchen I could see dog faeces everywhere.
”I was on the fourth stair when I saw that the step above me had a sizeable hole in it”
“He’s upstairs, follow me.” Mrs Rose led me to the corner of the room to a winding staircase which disappeared into a hole in the ceiling.
I followed carefully and I was on the fourth stair when I saw that the step above me had a sizeable hole in it. Mrs Rose neatly stepped across to the stair above.
I was led to a room completely taken up with a huge bed, almost filled with who I assumed was Mr Rose. The smell was one I was familiar with: rotting leg ulcers.
There began a three year relationship where I was tolerated because I was useful to the couple, and the start of a battle of wills to improve the conditions the couple were living in. It was always in my mind that I was a guest in their home with no real power to change anything if they didn’t want me to.
My starting point was to get a bed downstairs as we were all at risk of falling down the hole in the stairs in the dimness. This took a month of wrangling and I am ashamed to say, veiled threats of hospital admission before they agreed. They needed me to help them so complied eventually, after I refused to go upstairs for my own safety.
The day arrived at last and a new hospital bed was delivered. I knocked at 4:30 pm as usual and waited for the shuffle to the door. I had told Mrs R that she needed to make sure that the dogs were out of the room for my arrival as they presented an infection control risk, which sent her into a tirade of swearing.
”Those dogs are cleaner than you, traipsing in and out of people’s sick beds all day,” she told me.
She agreed partially to my request and only five of the smaller dogs greeted me on each visit.
”I could see as I entered that Mr Rose was resplendent (as much as he could be in the grime) in his new bed”
I could see as I entered that Mr Rose was resplendent (as much as he could be in the grime) in his new bed and I started to get the dressings ready. As I opened the dressing pack which was on the bed as this was the only surface I could use, and the saline sachet and poured it into the pot, Maisie the youngest of the dogs jumped on to the bed sending everything flying. As I tried to retrieve the dressings from the filthy floor Mrs Rose flounced in from the kitchen shouting; “If you’ve poisoned my baby with that stuff I will never forgive you!”
”Mrs Rose, can you please take Maisie out she can’t touch the dressings? They have to be clean for your husband’s wound.”
I tried not to show my irritation and as I set up again I caught a glimpse of a wry smile on Mr Rose’s face. “You’ll be lucky,” he whispered.
I was never allowed in any rooms other than the sitting room so I couldn’t wash my hands in the house, which was probably a blessing. I had to keep hand wipes and antiseptic gel in the car to clean my hands.
We continued to have an uneasy relationship for several months where compromise was needed, usually mine, until the day Mr Rose had to go into hospital for treatment of an infection. There began a period of turmoil for us all as the ‘authorities’ started to look into his welfare at home. Disaster.
”We continued to have an uneasy relationship for several months where compromise was needed, usually mine”
After he had completed his treatment in hospital he was moved to a care home in readiness for his return home. When I visited him there he was unrecognisable from the man seen only in the partial light of the cottage. His hygiene only distinguishable by the odour he emitted. To see him clean and well-nourished was a pleasure and he actually looked happy, chatty even.
I asked him gently if he wanted to go home or if he would he like to stay where he was so that he could receive the care he needed. He was adamant that Mrs Rose was waiting for him and he wanted to be back with her as soon as he could. There began a process that would take them to the edge and put their home and, ultimately, their lives at risk.
I initially got the blame for what happened next as I was the only link to what they saw as the ‘powers that be’. The state of the Rose’s cottage was well known to the GP practice and we worked within the boundaries set. It had taken weeks of work to gain access in the first place and despite all the advice and suggestions to improve their conditions over the time I visited them, they always declined firmly.
Mr Rose’s imminent discharge home had a different set of rules applied and there had to be an inspection to see what help and equipment he would need to assist him. I persuaded Mrs Rose that I needed to look around so that I could get Mr Rose the help he needed.
”I initially got the blame for what happened next as I was the only link to what they saw as the ‘powers that be’”
I had never seen the bathroom and Mrs Rose had been sketchy in the information she gave me. “We go out the back” was the only response I got in my questioning as she pointed vaguely to the shadows of the kitchen.
After half an hour of cajoling she finally agreed to show me the other downstairs rooms, knowing that if she didn’t Mr Rose wouldn’t be able to come home safely.
She led me reluctantly to the door at the back of the sitting room revealing a small kitchen with a filthy cooker and not much else. Taking up most of the room was a large tin barrel about four feet high.
”Where is the bathroom, Mrs Rose?” I asked, thinking it must be further back behind the kitchen.
”There’s no bathroom, we have a wash down at the sink and manage very well.” She was defensive and I knew that I was prying and that she wouldn’t have tolerated it if it wasn’t necessary to get her husband home.
”Looking at me directly with steely eyes, she pointed to the tin barrel”
“So where is the toilet?” I asked. “Will Mr Rose need a commode?”
Looking at me directly with steely eyes, she pointed to the tin barrel. “We do our business in a bucket and then put it in here.”
I tried not to show my disgust as she tipped the barrel towards me to show me the contents of several weeks of sewage, the stench hitting my nostrils, making me step back.
“And where do you empty it?” I asked, not really wanting to know the answer. She opened the back door to a garden which consisted of what looked like a slurry of mud dipping down to the rippling stream.
“When it gets full I tip it out here. It goes in seconds, the worms love it.”
Nurses are trained not to show disgust or disapproval but I have to confess that I found it hard not to show my horror at their method of disposing of waste.
Despite telling her about the risks of continuing to use the barrel, I was ignored. The only concession made was that she consented to having a commode for her husband. A commode that would be emptied the same way as the bucket. She walked out of the kitchen to the front door, opening it for me to leave. The conversation was over.
Offers of home helps and meals on wheels were declined with a shrug and Mr Rose was sent home cleaner, well-nourished and happy back to the environment he had left behind.
We went back to our old routines until a week later when I knocked at my usual time and was greeted with a torrent of swearing from Mrs Rose and a refusal to open the door to “you pigs”.
“A week later when I knocked at my usual time and was greeted with a torrent of swearing”
It took me an hour of pleading through the letterbox before I was allowed in.
“What is it?” I asked. “Who’s upset you?”
Eventually, they told me that the health visitors had been to do a home assessment.
“I should never have let them in but they said they were from the surgery and I thought I had to,” a tearful Mrs Rose told me. Mr Rose sat in the bed silently wiping tears from his cheeks.
”They told us that the cottage needed condemning and that the dogs would have to go to kennels or be put down until things are sorted out. So we’ve decided what we’re going to do and you won’t need to visit anymore.”
”What do you mean?’ I looked at the faces of two elderly people whose world in one instant had turned upside down. A world that we may see as disgusting, but to them this was their bubble where they lived happily together.
“I can look into this Mrs Rose, I am sure they didn’t mean to upset you.”
”I looked at the faces of two elderly people whose world in one instant had turned upside down”
”Sheltered housing they said.Why would we want that? This is our home and no one is getting us out of here. That’s why we have decided what to do. You can go now.”
“What do you mean?” I asked. “Let me speak to the doctor and sort this out for you.”
”No, we’ve got everything ready. We’ll give the dogs their pills first and then take ours so that we can all go together.”
I looked into the eyes of the tough old lady and saw her vulnerability and determination. I believed that this couple would take their own lives rather than leave their home.
I couldn’t go, I had to get this sorted out at once. The GP needed to come and reassure them that they couldn’t be removed from the cottage, he was the only authority they respected.
He was there within the hour and spent the rest of the afternoon apologising for the way they had been treated and assuring them that nothing would be done to remove them or their dogs.
I continued to visit the Roses for another year and Mr Rose became dingier with each week despite repeated efforts to wash him. The dogs started to die of old age and the couple became frailer.
When Mrs Rose had a heart attack and died we were able to persuade Mr Rose to return to the care home where he thrived for six months before a stroke took him.
I drove past the cottage most days after that and it somehow seemed to shrink into the side of the hill with its feet in the stream.
Sue McCready is retired from the NHS and now works as a CQC inspector
*Please note: Names have been changed to protect confidentiality