by Kamouraskan

Disclaimers: Story copyright to the author May 2004.

Frances is an 89 year old woman with dementia. Before the death of her husband Albert, she lead an active life. She was babysitter to her two grandchildren, but after several incidents, it was agreed that it would be best that she give up caring for them. Soon after, her husband was diagnosed with terminal cancer. Through this period, Frances declined rapidly and often woke Alfred in the night worried that the grandchildren were lost. Alfred kept his diagnosis from her, and when he finally succumbed she was shocked and confused by the news.

For a time, Frances lived with her daughter, but this did not work out as Frances was now exhibiting severely challenging behaviour.

Challenging behaviour being code words for aggressive and paranoid actions.

Frances has now been in the home for two years and her dementia is significantly worse. She does not seem to recognise staff who she sees everyday. She is incontinent of urine and faeces. She frequently refuses help in washing although she is not able to do so independently. She often asks for her grandchildren and her husband and continually makes requests to ‘go home'. Her verbal skills are otherwise quite limited and she tends to repeat questions and phrases over and over. She seldom has any kind of visitor. She had recently developed severe bedsores that required her to be bathed daily by the night staff of the Home.

The perpetually understaffed Riverside Senior Care Home.

Nurse Richardson turned from the file to her private casebook. Tomorrow night, Sunday, there would be only one night staff responsible for two units, each comprising of eight ‘clients'. The night staff was cheap labour, temporary agency placement personnel with little knowledge of the building or of the clients. Usually black immigrant, she observed tartly. Nurse Richardson made a short but precise notation in her casebook. It would not be very difficult to set off a patient alarm in the alternate unit as soon as Frances had been put into the bathtub. It would simply be a matter for Nurse Richardson to conceal herself in the adjoining toilet and wait until the carer had left to investigate the alarm. Then she could gently ease Frances' vacant eyes under the surface of the water for a few moments.

Entirely satisfactory from all aspects.

Nurse Richardson was not a callous individual. She reflected that some blame might be placed on the agency personnel. But hopefully someone in officialdom would comment critically on conditions that permitted one person to look after so many vulnerable people.

Unfortunately, it was just as likely that the home would manage the incident, certify the death as misadventure and with no family to be bothered, the home would simply continue as if nothing untoward had occurred.

So her project would have to continue as well.

There were a few personal risks that also had to be assessed. She would have to be officially registered in the home on some legitimate assignment, and would probably be asked by the panicking and inexperienced worker to call ambulances and doctors. She would prefer to remain in the shadows as long as possible in order to continue her work.

If only there was an easier way!

Katherine Richardson, RN did not believe that she was the angel of death or any such twaddle. She did not imagine that she had been appointed by God to perform these acts. It was not in her nature to harbour such nonsensical delusions. She did however, have a strong sense of compassion. It was simply a passing thought that supernatural powers would have made The Project, as she mentally referred to it, so much easier. If she could only glide through the units of Riverside Senior Care Home for the Elderly, dispatching her chosen ones with a light touch of her hand, there would be no need of alibis, or poison, or the relief from a suffocating pillow.

Not that she was squeamish of the act; decades of work as a district nurse in many such homes had long drained her of any distaste for death. Rather, it was helping to extend lives so clearly undervalued, so lacking in self-esteem or quality of life, that had become intolerable.

No, otherworldly powers were only to be envied because there would be no need for such subterfuge. She was certainly not ashamed of the Project, and it was not in her nature to be devious. But the indignity of arrest, of being a meal for the media vultures; that would not be allowed. Or to have the Project halted in its infancy. For those reasons, she would work quietly, under the radar, as they said in her day. She stretched her thin back muscles and began leafing through the client folders again.

Changing government standards and home ownership had left most of the long-term residents' files a multi-coloured jumble of paperwork. Much of the information was also outdated or mislabelled. One risk assessment had the box ‘can toilet herself independently' ticked, when Nurse Richardson was well aware that it now took the assistance of two carers to position the woman in order to relieve herself.

She noted with satisfaction that the medical reports alone were accurate to the date; each notation of the long list of medications made in a firm and correct hand.

Included in some of the folders was a detailed biography written only a few years ago. A young, and for a time enthusiastic, senior carer had compiled comprehensive assessments by surprisingly taking the time to talk to the residents and their families. Of course, the poor woman had only lasted a year before burning out rather spectacularly in tears and breakdown, but at least now Katherine could enjoy the fruits of that labour.

She read:

-Estelle has always been an active person, and spends the day on her feet and frequently wishes to go outside.

Unfortunately, as her dementia has increased, on several occasions she has become lost on trips to the local shops. She seems to have a good awareness of traffic and can cross roads safely, but her sense of direction is unreliable.-

A series of well meaning suggestions followed; some that might have allowed Estelle to continue to make trips, whether escorted or by notifying the local shopkeepers, allowing her to carry a cell phone, etc.

The actual decision was to be expected.

-Because of the risk of Estelle getting lost, staff and managers have decided that she should not be allowed to go out. Estelle's daughter fully supports this decision. However, Estelle has become depressed and spends the day pacing up and down, wringing her hands.

Soon, that problem would also be easily solved for the staff; Estelle was to have her tranquillisers significantly increased.

Nurse Richardson thought for a moment. Estelle would be very interested to discover that one of the exterior fire doors no longer had a working alarm. She'd be even more delighted to be offered an escort to go shopping, even if it meant being met outside in the riverside park that bordered the home. Nurse Richardson smiled, imagining how Estelle would slip out, with a new spring in her step, the afflictions of the dark home left behind.

Then the emancipation of a quick brick to her fragile skull.

Nurse Richardson could dispose of the unexceptional blunt weapon and Estelle's handbag in the nearby river and only the Home would be investigated, presumably for allowing a vulnerable woman to be robbed.

Nurse Richardson nodded to herself. It certainly seemed that this plan had great promise! Of course, there was always the possibility that Estelle might tell someone about the door and how she had learned about it, or that some inopportune witness might wander into view at an unfortunate moment, but those risks could be reduced with planning. Another notation followed. Definitely, a plan to consider. And bearing in mind that the alternative was that Estelle would soon become another medicated zombie occupying space in the lobby, incontinent and lost, Estelle would certainly appreciate the extra effort.

Humming lightly, she moved onto the next file.

Bob. Why wasn't Bob on her list? Blind, deaf and crippled, continuously medicated, Bob occasionally came out of a fog in order to attempt some form of solitaire, which only he understood. Lack of proper observation by the home had allowed him to have several damaging falls in the past few months. Another, more serious fall was certainly indicated. He definitely met the requirements for her special care and yet he wasn't on her list of six prioritised clients? Then she remembered. Once a year Bob's grandson made the effort to come and watch the cup finals, drawing from Bob's bank account enough beer to make his long journey worthwhile. Bob looked forward to those visits so much that, diverted by her compassion, she had considered postponing his ‘treatment' until after the game.

That riddle resolved, and another note made in the casebook, she moved onto Jane.

The client, Jane, is an elderly woman of heavy build with severe dementia. Wheelchair transport. Hearing aid. Unable to communicate. Seldom leaves her room.

Seldom leaving your room was considered a positive thing at the Riverside Senior Care Home. It meant less work. Persons who were mobile were likely to be tranquillised to replicate that condition.

Jane, she noted with interest, was on the same unit as Estelle and Bob, as well as three others of her special group. What if the entire unit were to fall ill?

It was worth considering. Certainly a mass death would be harder for the Home to hide under the carpet. Behind her, on the wall of the staff room, was an article concerning a poisoning that had occurred some years before. Five residents had died in a senior care home due to a mix-up of the washing fluid and the fruit concentrate. That idea seemed to have some potential for a moment, but as she worked out the details she found too many complications, especially as there would no doubt be a full criminal investigation.

Of course, there was always the obvious to fall back on.

Fire.

There was a malfunctioning toaster put aside in the kitchen, Katherine remembered. And what would be more natural than if a night employee brought it to this very staff room, presumably to light a cigarette? And the smoke alarm in this staff room was incapacitated for that unsavoury pursuit. Of course, no staff member would admit to having taking any of those actions afterwards, but what investigator would doubt it? And though not an agent of God, could she ignore the additional fortuitous coincidence that the staff room was connected to the very unit the majority of her charges resided? And would not God see that those more capable, survived the conflagration? Though she would remain to help those that had some hope or future quality of life.

Or possibly to trip those that had no reason to escape.

But it would have to be done immediately, before the toaster was thrown away or repaired. Was she prepared to act so quickly after such a long time of planning?

Yes.

Yes, the purity and purification of fire. Nurse Richardson had seen its destruction many times during her career. She saw in her mind's eye how it would feed on the piles of records, leap up the walls and run the length of the unit through the ceiling spaces without setting off a single alarm in the building. And there were no sprinklers in the Home. Certainly the deaths would force an inquiry into care standards and safety. And she, Katherine Richardson, with the help of her charges, would truly have changed things for the better.

But such an incident would not relieve all of her charges. There was one more. Katie.

Katie was an uncomplicated situation. Her slight size and body weight meant that her heart medicines were of the smallest dosage. The far higher dosages were in similar pill casings, and it would take only a moment to substitute her pills for another resident's. They were even put out, in advance, in a room she to which she had access.

Katie is regarded as a challenging resident, diagnosed with severe delusional dementia. She is frequently abusive to staff and despite being relatively frail, has on occasion spat and kicked at staff. Sometimes her abuse is of a racist nature. As she once held a position of responsibility, she frequently believes she is still in such a position and enters offices and resident's rooms without permission. She has accessed files and carries a notebook with pages of unreadable scribbles she refers to as her casebook. Any attempt to examine it has led to distress for both staff and Katie. A new psychiatric assessment is highly recommended and it is advised that she be removed to a psychiatric caring facility.

Where she would be drugged to within an inch of what would be left of her life.

Katie could be dealt with immediately. In fact, she could make the pill substitution now, and it would be in Katie's mouth by Sunday morning. Once she was out of the way (and for a moment, an unreasoning pleasure gripped her for no reason she could fathom) Nurse Richardson would be free to set the fire that very Sunday evening. The combined multiple cause deaths would surely begat a full investigation and the Riverside Senior Care Home would be closed. Its avaricious and uncaring owners would be taken to court and the lives of many would be ultimately improved. Katie's immediate death was the key, she knew that somehow. Then everyone would know, would see.

Katherine Richardson, RN found she could hardly wait to read the Monday newspapers headlines. Photos of the fire, of the owners of the Riverside Senior Care Home running like rats from the flashbulbs. She closed her eyes in rapture.

And if not, she considered more calmly, the Project could continue elsewhere. There were so many private homes, so many rapacious owners.

While inside her mind, flames flickered and burned.

Monday, April 12

Katherine (Katie) Richardson, RN

Suddenly, at age 92. Former District nurse for this county, deeply mourned by several nieces and grand-nieces. After a long and distinguished career of over 40 years service, she retired in 1977. Following a long illness was taken into county care, where she died Sunday of an accidental overdose.

In lieu of flowers, the family asks that all donations go to the Riverside Senior Care Home.