Saturday, 22 October 2016

A sad and difficult retirement

Cuboid salt crystals
Wieliczka salt mine, July 2016
About two years ago at work, my colleagues started to notice that one of our number was behaving strangely. I hadn't been working there for long enough to see any change - I just thought she had always been a bit forgetful. It became clear that this memory problem was chronic, deteriorating, and worst of all, she flatly denied that anything was wrong. Aggressively, sometimes. If errors were pointed out, she would pass blame to someone else (she hadn't received the message), or insist that the error didn't exist (she had in fact processed the invoices that hadn't been processed), or just shout at the colleague that they were wrong.

This was incredibly difficult to address. It's no good going to a more senior manager saying that something is wrong when the individual involved insists that it isn't. Everyone makes mistakes, and without listing every minor error that supported the issue it couldn't be proved to be anything other than a nurse being a bit inefficient. Her skills were intact - she would have no trouble starting someone on insulin, or analysing a blood glucose diary to suggest how medications might be adjusted. She just wouldn't remember being asked to do it, and would then deny all knowledge of the matter.

The technology started to become important - everything had to be emailed in order to prove that an issue had been communicated. She wasn't very good with technology though, and emails just languished in an expanding inbox. But emails and text messages started to form evidence of the problem - emails answered twice or not at all, repeated text messages about the same issue. I was protected from the worst impact because I do a different job, but the main nurse in a similar role was doing her own job plus part of her colleague's and simultaneously unable to challenge the situation while being abused for encroaching on her territory or for pointing out errors that needed to be addressed. It was an awful situation.

If only the patients had complained. Some of them could see that something was wrong, but "didn't want to get anyone into trouble." Without backup from service users our hands were tied - there simply wasn't strong enough evidence of the right sort, and every day we feared that someone would actually be harmed - not so much from the wrong action, but from inaction when action was needed. It seems that patients will put up with almost anything without complaining. Similarly the doctors - they must be used to asking people to do things that aren't done, because they made no formal complaint either, even though they could see that all was not well.

It didn't help that she had a strong and long-standing connection with a very senior and very influential member of the team, who took her word for it that she was absolutely fine. A whistle-blower would be in big trouble if the case wasn't watertight and beyond doubt. And the case wasn't strong enough to withstand this level of scrutiny.

Eventually, at long last, a bit more than a year ago, she had some leave booked and we all breathed a sigh of relief - we wouldn't have to deal with the daily stress of it for a whole week. On the Monday, however, in she walked as if it was a normal working day. This was too much for us, and finally she was persuaded that she was on annual leave and it wasn't appropriate for her to be in work - obviously all her clinics had been cancelled and she didn't have patients to see. We were all incredibly thankful that she didn't return after the week off - the reason was reported as 'stress'.

It took a while before we regrouped - there had been a distinct split in the team between those who were convinced by her and thought that actually there wasn't anything that a bit of a break from work wouldn't sort out, and those who could see it was more serious than this. But we all had a period of thinking "Maybe it is just stress, and she will come back, and it will start all over again," and this made our hearts sink.

Gradually we started to make changes in the department, and relaxed in the freedom we now enjoyed, apart from obviously the one nurse left had the workload of two nurses. Our colleague was signed off work for a long time, and we heard snippets of gossip from people still in touch with her, but nothing official. Her friends told us she was fine and looking forward to coming back to work. We were torn between hoping that she really had recovered from a bout of extreme stress, and concerned that it was the same cover-up and nothing had changed.

At Christmas she came into work for a festive lunch and brought us all Christmas cards, seeming utterly normal. As usual, she gave the impression she was looking forward to being back at work in no time. She expressed her sympathy for a colleague whose grandfather had been ill and had recently died.

Later that day, she arrived back at the department with a carrier bag. "I've brought your Christmas cards," she announced.

Next day she texted the colleague. The text said "How is your grandad?"

We heard little more for a month or so, but then we were informed that the powers that be could find no good reason for keeping her away from work. Occupational Health were satisfied that she was physically healthy and had recovered from whatever it was that was wrong. We thought otherwise, but couldn't prove it - the issues at Christmas might have been part of the problem of stress, and officially she was now better so everything would be fine. We did have a meeting where we expressed our reservations to management, and it was agreed that before coming back to the department and interacting with patients she would be located in an administrative building and would complete the mandatory training that she had missed while off work.

That first week we awaited developments with trepidation. It was to be a phased return starting with just a couple of mornings, but we anticipated some issues, and we were right. She arrived at the department and settled down in her old room. We had to call management, who persuaded her that she needed to be elsewhere. Our main concern was that patients would see her and assume she was back at work, then ask for help or advice and she would start to provide it. It was extremely uncomfortable having to call the authorities behind her back.

After several false alarms when she continued to turn up at the department, she seemed to accept that she needed to be elsewhere, but we were continually on edge in case she arrived unexpectedly. After just a couple of weeks we were told that as she seemed perfectly fine, she would be coming back to sit in with the doctors as a precursor to returning to her old job. All hell broke loose.

Luckily our insistence that this was completely unacceptable was acknowledged, and it didn't happen. Her perfectly rational outward appearance and conduct was very convincing, but eventually it became clear even to those supervising her mandatory training that we were right. The thing that we all struggled with was why she didn't acknowledge that something was wrong, and accept retirement gracefully? Had we been in her situation none of us would have minded leaving work, even if the reason was as unwelcome as incapacity. Why fight so hard to avoid an easy life of leisure and insist on coming back to the environment that had provoked the 'stress' in the first place? Especially so close to actual retirement age.

Very little information reached us throughout the next period. Officially it was not for us to know details of the negotiations taking place, but occasionally something would filter through, usually through contact with those colleagues she remained in touch with. The consistent message from her was "I'll be seeing you soon, I'm coming back to work next week." After our initial panic we learned how to react to this, generally with a good humoured "That'll be nice, see you then." Her powerful senior ally continued to imply that while she may not come back to work with us, there seemed no reason why an alternative sinecure could not be found.

After a year on sick leave, it was finally confirmed that she would not be returning to work, and for the first time in two years we could relax. A 'retirement' lunch is planned, a card and collection are circulating, and we have put measures in place to try to ensure that she doesn't miss her own lunch by forgetting about it. She popped into the department the other day, and told us that she might be coming back to work for a couple of days a week in a different role. "That'll be nice, see you then," we said.

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