Senility seemed to reveal hidden racism inside some of the sweetest old men. Every Friday evening at the hospital, the last weekday shift would hand over to the first weekend shift. Weekend shifts were mostly covered by agency staff. Many of the agency nurses were of African descent, which was a fact that failed to escape the notice of otherwise unobservant geriatric patients.
"I am a nurse. I am a fully qualified, registered nurse" one of the agency nurses stated calmly to an irate patient. This was not an uncommon situation she had to deal with.
"How can you be a nurse? You're not even English" said a man, his voice raised.
Lara could hear the conversation between nurse and patient from down the corridor. She had her coat on and was carrying her handbag. She was now making her way out of the building to the car park. Her working week was over. She had a tough decision to make: did she continue taking the most direct route to the lifts, or did she turn around and take the back staircase down to the basement, and walk round the hospital to the staff car park? She decided to press on. Her uniform was mostly covered by a long coat.
"Nurse! Nurse!" shouted the old man, as Lara scurried past an open door, keeping her eyes fixed straight ahead. Glass windows either side of the door allowed anybody walking along the corridor to be easily be seen from the ward.
Lara knew that the old man was trying to get her attention, but she also knew that nothing could be achieved by involving herself in the altercation. The old man would never accept that not all nurses looked like Florence Nightingale and Britain had become a multicultural society during his long lifetime. Tragically, it was part of the job description, that agency nurses would have to deal with this kind of mistreatment over the weekend, when the familiar weekday staff were mostly not working.
Stepping out of view into the lift lobby, Lara felt a twinge of guilt for not taking the stairs, but this was outweighed by the sense of relief that the weekend was beginning and she could start to relax. A pair of metal doors slid open and Lara squeezed into the lift. Leaving the building at this time was always busy. Every lift going down would be packed full of people.
The hospital was a modern monolithic white cube, 5 storeys high. It was the largest hospital in the county. Built on the outskirts of town, the hospital was surrounded by a sprawling car park, divided into short stay, long stay, and far away from the main building, a car park for the general staff members. Near the staff car park was a second building in the same architectural style as the hospital, but much smaller. This was the accommodation block where many of the younger nurses lived.
As Lara reached her car, a group of young women spotted her and started calling her name and waving for her to join them. One of the group sprinted over to where Lara stood, frozen, car keys in hand.
"Will you join us for a drink?" asked Lara's friend, Anne.
"I'm sorry, Anne, I've really got to be getting home. Neil's not well" Lara replied.
"Still?" Anne asked, slightly shocked.
"Yeah. Don't know what's wrong with him. I hope he's been to see the doctor today"
"Oh dear. Well, maybe you'll come out another time?" Anne asked brightly, clearly not wanting to stress Lara out any more and slowly backing away to rejoin the group.
"Sure" said Lara, relieved that Anne could see she was keen to get going.
Anne skipped back to her other friends. Lara knew most of them. They were all a little younger than Lara and they had bonded through living together in the staff accommodation block. They had been very welcoming and friendly and Lara was grateful for the opportunity to socialise outside the group of familiar couples that she and Neil spent the majority of their time with.
Jumping in her car as quickly as she could to avoid any further attempts to pressurise her to go out for a quick drink, Lara gave an apologetic wave as she drove past the group on her way out of the car park. Young and carefree, full of energy, all her workmates waved back enthusiastically. Lara's heart sank a little, because she knew how much fun and refreshing it was to spend time with them.
Pleased to find a parking space quite near her house, Lara was also pleasantly surprised to see that there were lights on downstairs. This was the first time this week that she'd returned home to any signs of life.
Opening the front door and stepping into the hallway, Lara hung her coat on the coat rack and dumped her handbag on the floor. The door to the snug was open and Neil was sat on the large sofa, studying a large piece of paper covered with tiny print. The paper had many creases in it from having been folded up very small. On the coffee table sat a small white cardboard box with a printed prescription label on it. There was also a small white paper bag, emblazoned with the logo of their local chemist, open on the coffee table too.
Neil seemed engrossed in reading the tiny print on the piece of paper. It had also become their custom that week for Lara to have to initiate any conversation.
"So, I take it you went to the doctor?" she asked.
"What? Er, yeah. I got this" Neil distractedly replied, as if the rest of the story was implicitly clear.
Lara stifled a sigh and went upstairs to get changed out of her work clothes. Clearly she was going to have to drag the rest of the details out of him. Frustration replaced a sense of relief that Neil was up and about and had finally sought a doctor's opinion.
Unhurriedly making her way back downstairs, Lara sat down next to Neil on the sofa. She was close, deliberately invading his personal space in the hope of waking him from his trancelike state, studying the leaflet that must have accompanied the medication that he had been prescribed. Neil paused and looked her in the eye for a fraction of a second, but then feigned continuing to read his leaflet.
"So, what happened, at the doctor?" Lara patiently asked.
Neil went to answer but then held his words back. He opened his mouth as if to speak but then froze and it became clear he didn't know how to begin. After a moment, his face flushed and he started to blurt out words.
"They called my name. I sat down. Asked how she could help. Burst into tears. Couldn't stop crying" Neil haltingly said. He was emotional, but he didn't seem like he was on the verge of tears. He seemed somewhere between embarrassment and confusion.
After a moment, he seemed to calm himself down and he began again, more relaxed than before.
"The doctor said it was OK and I should take my time. I started to tell her that I couldn't get up in the mornings. I couldn't face going to work. I couldn't face the world. I was tired. So very tired"
He took a breath. He was blurting his words out very quickly.
"She asked how long it had been going on for and I told her a few weeks..."
"A few weeks?" Lara now interjected, even though she was clearly cutting Neil off mid-sentence. Her mouth hung partly open, further betraying her shock.
"I mean the tiredness. Not the getting up" Neil replied.
"Yes, but why didn't you say something before?" said Lara in a tone that was concerned, not angry. She was reacting reflexively, but she knew she had to try to control herself if she wanted to avoid upsetting Neil.
"The doctor. She said I sounded as though I was depressed and anxious" said Neil, ignoring the question. "She asked me if I had heard of flux-o-tin" he said.
"Fluoxetine?" asked Lara, enunciating the syllables - flew-ox-ah-teen - with a little emphasis, but not so much that she would sound patronising.
"Yeah, that one" replied Neil. "She said that many patients found that it helped them when they were feeling anxious about things, like work stress, as well as low mood. She said that my symptoms could be caused by an imbalance in my brain chemistry, and fluoxetine often helped to balance it out" Neil continued.
"Yes, I know fluoxetine. At work I have to help patients take their prescriptions that they bring from home. Quite a lot of them take fluoxetine. It's the same as Prozac" Lara said.
"Prozac? Well why doesn't it say that on the box or any of the leaflets?"
"Sometimes the pharmacy gives you a branded medication, sometimes they give you a generic version. At work we have to learn both the brand name of the medications as well as the active ingredient" Lara explained.
"But everybody's heard of Prozac" Neil stated, his voice now tinged with a degree of frustration.
Neil sat forward on the sofa and cast the leaflet he had been holding onto the coffee table with a dismissive flick of the wrist, before slumping back, looking away from Lara and staring up at the ceiling. Lara had seen this kind of reaction before at work when she saw doctors speaking to patients; normally young men. It was a kind of shock and disbelief; denial even. Lara couldn't understand why Neil was having this reaction now, with her, rather than earlier with the doctor.
"So I'm on Prozac. Great!" said Neil, his voice dripping with sarcasm.
"You know I've got to take this stuff for at least 6 weeks?" he said, now shaking the small white box at Lara, which rattled with the sound of the pills inside in their blister packaging. The question was rhetorical. He needed to vent.
"I felt relieved when the doctor signed me off sick for another two weeks, but now I don't know what to feel. Can you believe that the doctor even asked me what she should write on the sick note? Stress, anxiety, depression or just mental health problems. I didn't know what to say. She put me on the spot. I said she should write stress"
Lara reached for his hand and squeezed it. She made a sympathetic face.
"They're doing some blood tests too. Could be an under-active thyroid. Won't know until next week, but that's more what I was expecting, you know? Something physically wrong with me"
"I hate to bring this up, but we had planned to have dinner with Russ and Katie tonight. Do you want me to cancel? I'll ring them and come up with some excuse" Lara gently offered.
"I don't know. I don't know anything anymore. I'm confused. I'm upset. I'm frustrated" said Neil, standing up.
Looking down into Lara's eyes as she sat on the sofa, she sensed Neil's care for her and his awareness of her feelings too, but his thoughts were in turmoil. He turned and went upstairs. She heard him kick off his shoes and get into bed.
Neil was asleep, fully clothed, when she joined him in bed a little later. She guessed that it must have been an emotionally exhausting day for him. Perhaps it was side-effects from the medication.