Sunday, 28 October 2012

Social Work with the Dead

Perhaps it’s the dismal weather we’ve had recently, perhaps it’s the shortening days. Whatever the reason, I’ve been thinking quite a bit about the dead. In particular, my first hand encounters with death.
Thankfully, I’ve seldom come face to face with a dead body during my career as a social worker. However, on four occasions I have been in the unfortunate position of being directly involved in the discovery of a recently deceased person.
I have already written about two of these on this blog. One was many years ago, but still sticks vividly in my mind. I wrote recently about this sorry tale only last month in Origins 5: Death in Charwood. The other was the case of Lenny, who I wrote about back in July 2011 (Lenny: A Life and Death in the Mental Health System; you can read it here and here).
Because encountering a corpse in social work is so rare, when it does happen, it’s not something you tend to forget. So here, then, are accounts of the other two.
George was in his 50’s and was a  longstanding patient of the Community Mental Health Team. He had a very long history of chronic paranoid schizophrenia, and was on a range of antipsychotic medication, including a fortnightly depot injection. Although I was not his care coordinator, I had had to detain him under the Mental Health Act on a couple of occasions.
One day, Jim, his community nurse, went round to his house, where he lived alone, to give him his fortnightly injection. He had been unable to get a reply. Jim returned to the CMHT and discussed this with me.
It was not like George to be out on the day his injection was due, or not to answer the door. We decided to go out together to investigate further.
We rang the bell and knocked on the door, but there was no reply. The curtains were drawn, but we could hear the television. Jim knelt down and peered though his letter box.
“Oh, God,” I heard him say, as he backed away.
“What is it?”
“I can see him. He’s sitting in his chair in the living room at the end of the corridor. He’s not moving. I think he’s dead.”
I had a look myself. His profile could be seen clearly through the open door of his living room. His head lolled to one side, supported by the wings of the armchair. I called, but there was no movement. I feared the worst.

We decided to call the police.
When they arrived, we explained the situation to them. They too had a look through the letterbox, then tried to find an open window or unlocked door, without success.
One of the police then revealed an arcane piece of knowledge. The windows on this estate all slid within a groove in order to open them. There was a way to jiggle the window so that it could be slid back a little way, even though there was a window lock, and then it was possible to reach through and release the lock so that the window could be opened enough for a person to climb through. He didn’t tell me how he knew about this.
The police officer climbed into George’s house and opened the front door. We all entered and went into the living room. His eyes gazed sightlessly at the morning TV programme. He appeared to have been dead for at least a day or so.
Once we had formally identified the body, we returned to the CMHT.
Jim was pale. He was badly shaken. He was looking at something far away.
“So lonely,” he said. “So alone. Looking down that long corridor through the letter box, there he was. He died on his own. He was so alone.” He began to cry quietly. There was nothing I could do for him.
One morning I had a call from one of my service users. Beth was a middle aged woman with whom I had been working for several years.
Not long before I first started to see her, she had finally escaped a long, abusive marriage to Gordon. Gordon was an alcoholic. Throughout the marriage he had terrorised her, undermined her, hit her, and sponged off her.
I had helped her through the aftermath of this, including aiding her resolve not to return to him, affirming her decision, and assisting her to go ahead with a divorce. Over time, she had adjusted to being a single parent, and her confidence in her own ability to be a parent for her children slowly increased.
In recent months, after a long time with no contact, she had started to see him again – not because there was any prospect she would return to him but through pity. Because of his drinking, he was in very poor physical shape. For the sake of the children, who still had contact with him, she wanted him to get help for his drinking and also tried to persuade him to see his doctor, as he had lost weight and was physically quite frail, even though he was only in his early 50’s.
“Masked AMHP,” she said, “I’ve been round to Gordon’s flat, but I can’t get any reply. I was going to do his shopping for him. I’m sure he’s dead. I’m convinced of it.” She began to cry.
I arranged to pick her up and go round to the flat again. Sure enough, there was no reply. She has last seen him a couple of days previously, when she had done some shopping for him. He never left the flat. So I called the police.
The police managed to get a key from the housing association, and I arranged to meet them at the flat. I persuaded Beth not to come. I didn’t want her to be in the position of having to identify the body, if our worst suspicions were realised. She didn’t want to, anyway.
I went into the flat with the police officer. We found Gordon huddled on a sofa. He was dead. He looked tiny, emaciated, desiccated, almost mummified; there was hardly any weight to him. He didn’t look as if he could ever have been alive, somehow. Although I had never met Gordon in life, I had no doubt it was him. His skin was a deep yellow, almost mahogany. I had never seen anything quite like it.  He had clearly been in the last stages of liver failure.
Beside him on the floor, still in a carrier bag, was the last shopping that Beth had done for him. Still in the bag was a 3 litre bottle of white cider.
I went to see Beth at her home. She was crying profusely. I told her roughly what had happened. I didn’t give her the details of his appearance.
“I killed him, you know,” she said in between gulps of air.
“What do you mean, Beth?” I asked her.
“I didn’t want to. He made me.”
“What do you mean?” I asked again.
“He made me buy him some alcohol, that last time,” she wailed. “I knew I shouldn’t have. I killed him.”
“Beth, he never opened the bottle. He didn’t have a drink before he died. It was drink that killed him. But not that particular drink.”
Over the months following this incident, I had to spend many sessions helping her to work through her bereavement and guilt issues. But the fact that I had gone in that day, and had found that bottle, and had seen that it hadn’t been touched, and could tell her this, certainly helped to absolve her of at least some of her guilt.

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