The Couple and the Dog (originally posted in 2016)

It was a relatively quiet day with a steady flow of people on board the ManVan.  Three phone calls in relation to one client in the morning and a face to face meeting before lunch ended up taking up most of the day.

The face to face client attended to see the nurse primarily. Three separate cancer diagnoses bringing them to us. One has been treated, the other awaiting immediate surgery, the last awaiting recovery from surgery before radiotherapy. And that’s just one of them. The significant other suffering with the after effects of a stroke and heart attack. Prior to June 2014 they did not have any of the above conditions. Twelve months they wish to get over.

I was invited into the appointment as there were other practical issues on their mind. A colleague was already dealing with an Attendance Allowance (AA) application and had been liaising with their GP to obtain medical records. Another colleague had been trying to contact them to organise a counselling assessment for both of them to help them come to terms with their life of the last 12 months. They had also had conversations about social care involvement as the carer responsibilities are going to be stretched while he is receiving and recovering from treatment.

When there are so many things floating around it is easy to lose sight as to what one’s priorities are. They definitely fell into this category. They were facing a scary and life changing surgery and trying to do it with as little disruption as possible. It is a lot to carry on one’s shoulders, particularly if they are trying to shield their children from the extent of the diagnosis.

On top of this they have a 13 year old Shih-Tzu that has an immune deficiency disorder and requires eye drops daily. When the heart attack happened a neighbour was able to care of the dog. This could not happen now. It was interesting to see the emotion in their faces as they considered what would happen to the dog during the next couple of months.

I enjoy my job because I can provide structure. I can provide next actions and to-do lists, not just for me, but for patients also. I can dispel myths.

Due to our case management system I was able to see what each of my colleagues had completed and what their next action was to be taken. I could therefore say with certainty that the AA was in hand.

Secondly, I considered their caring position. They have savings, they did not feel comfortable disclosing the amount, but capital is important when looking at help at home. I was able to make them aware of social services and what services they can provide. I made them aware of their duty to assist those in need and that a Care Plan can be made and implemented. They are now going to broach the idea with the consultant to ensure that discharge, and care of the partner, is catered for.

Third point. I could confirm that our counselling service had tried making contact and could find out more about what they are trying to get out of speaking to a counsellor. I could confirm that the counsellor would get in touch to help them make sense of what was going on in their lives prior to his surgery. They were very comfortable with the concept and are looking forward to a safe environment to air their feelings.

Fourth point. The couple did not feel comfortable sharing their savings amount. It was their pot saved for retirement and to pass on. They had already dipped into it and could see the value dwindling. They did not want a means assessment for Pension Credit, but I didn’t think they fully understood the tariff income rules for pension age claimants. Tariff income is the assumed weekly amount for a value of savings as set by the Department for Works and Pensions; at present, £1 for £500 over £10,000 is deducted for savings value over £10,000 for Pension Credit claimants. They didn’t disclose their amount to me, but I can still advise in the hypothetical. The impact of Pension Credit can help with travel, dentistry, opticians and Council Tax Reduction at 100%! They will now consider it.

Lastly, the dog. Following the appointment I updated the others of the appointment and what the expectations were of the couple. I updated their record on our database and, I’ll be honest, I wrote a mini essay. I believe in writing down as much as I can so that when I look back, or a colleague reads through the notes, I can recreate the vibe of the appointment. In my write up I mentioned the dog and the emotion I witnessed. Never underestimate what your colleagues can bring to a case – they knew of a volunteer group of dog fosterers! I was immediately on the phone to provide them with the phone number.

They entered the Van with no set direction and worry of upcoming surgery. They left with certainty as to finances, nurse support post treatment, counselling services, knowledge of care plans, and a place for the dog!

I strongly believe ‘patients are just people with an illness that requires treatment’, and it was a pleasure getting to know them and guiding them through what was going on. I found that she had been a “fabulous” Mezzo Soprano who trained in a conservatoire in Cardiff and that he was a founder member of a male voice choir in their hometown. When I mentioned our Sing with Us choirs the atmosphere changed. Although they are weaker than they used to be, and she knows she is no longer able to be a Mezzo Soprano, you could see they were reliving events and songs in their heads. Large smiles across their faces. I love the power of music. 

They left with the full address for the choir and my hypothetical circumstances in hand. Now, with a number for the dog. No stone was left un-turned and I am proud of the way that we looked at the two of them as people.

A handshake at the end of a meeting can give a good indication as to how things went. Men have difficulty sharing feelings or showing what impact a service has had on them. His handshake and, “thank you”, left me in no doubt as to the impact we had had on the pair of them.

I wish them the best of luck with their treatment and recovery, and hopefully, when it is all over, I will see them join the choir; to once again fill their life with music and smiles as it has done throughout their life.


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