Once upon a time an elderly woman looked forward to Christmas for a very special reason. She was “Mother Christmas”. She had a red dress with a white trim and it was her task to give out the presents on Christmas morning in the residential home where she lived.
Miriam, as she will be known for the purpose of this writing, was in her 70's.  She had lived all her adult life in psychiatric hospitals.  The reason for her original admission is unclear.

She had a male friend who had lived with her in the hospital who had died approximately one year previously. She was moved to a residential home for older people with mental health problems. Miriam had been diagnosed with Bi-Polar (manic depression) when 20, according to records. She had been taking medications for the condition since diagnosis. The medications were no longer effective and had major side effects.  She had very extreme mood swings which resulted in huge "highs" when she couldn't sleep, talked incessantly and was unable to relax followed by extreme lows. During the “lows” she would sit with her head almost on her lap, not speak and be in a "semi-comatose" state for days at a time.  The “highs” were becoming much less frequent.  “Lows” were apparent most of the time.  She took very little interest in life, hardly ate and didn't even want to do her job as "Mother Christmas", something that was a major highlight in her year. When she was well enough she would decorate hats that she insisted she kept to show her social worker who tried them on.  She had no family involvement.

One day the social worker arrived for a visit. Miriam sat in her usual chair in her usual place. She was bent over and non-communicative. The social worker noticed a lost looking young female care worker standing nearby. She had the expression of some one who wants to do something about something but doesn’t know where to begin. The carer was about 20 at the time and new to the job. She had no previous experience of the work.  She was sweet and keen but without some of the skills she needed.  She had been taught the practical skills such as personal care etc, but found the level of Miriam's apparent distress difficult to deal with.

People had tried to speak with Miriam for some time but with out success. She would chat when she was “high” but now she seemed unreachable. There can be little more alarming than the feeling that we should act to alleviate some one’s distress but we seem powerless to do so. The social worker pulled a chair next to where Miriam was seated. She spoke softly to her. There was no response at all. She continued to speak with Miriam about things that she knew interested her. There was no response. The social worker took Miriam’s hand in her own and began to tell her things. Bits of gossip, chitter chatter and news of people she knew in the home. The one sided conversation continued for the best part of an hour. Occasionally Miriam would weakly squeeze the hand of the social worker.  After some time the social worker turned to the young carer, who was watching intently, asking her to take over while she had to go off to do some paperwork. There was no paperwork that needed her immediate attention but it was a tactic to involve the young woman who asked, “What shall I do?” with a slightly uneasy voice. Inside she was trying to hold down the fear she felt at the idea of failing, of not being able to help.

The social worker asked her to sit in a chair on the other side of Miriam. The social worker continued to chat to Miriam. Then she got up to move away. “What shall I say?” asked the carer. “Just chat to her about any thing that comes in your head”, came the reply. The young woman began to speak and as she did so she became more confident. It soon became quite easy, she thought, and she became more comfortable with the task. The social worker re-appeared after a short time and sat back down in her chair. The young carer continued to chat. The social worker announced to Miriam that she would have to go now as she had another visit to make. As the social worker stood up to leave, Miriam held her hand out to the young care worker who took it in hers. It was a small but significant break through. The kind of small change that opens the way for a greater improving change that can educate and refine the way we interact with our fellows.

After this, staff decided specific time would be allocated for the talking with, sitting with, and just being with people.  The young carer became the main ambassador and mentor of this activity in the residential home. Some times it seems as though there is nothing we can do when faced with great and complex human need. Some times the first steps towards a solution are small, simple and within most peoples capability.
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