over her dog? ‘Fine, thanks,’ he said.
‘Good. If you haven’t brought anything with you for lunch, there are a few cafés plus the deli and the fish and chip shop along the harbour front—and of course Scott’s do the best ice cream in the area. Abby Scott—well, Powell, since she got remarried to Brad—has even developed a special ice cream for dogs. Toni’s one of her most loyal customers.’
‘Ice cream for dogs?’ He’d never heard of such a thing.
‘Archie loves it.’ Moira smiled. ‘Everyone loves Archie.’
Pretty much what Toni had said to him. In his view, the dog still had no place in a doctor’s surgery; though Ben rather thought he’d be on a losing wicket if he protested any further.
* * *
‘Hello, Ginny.’ Toni kissed the elderly woman’s papery cheek and sat down next to her. ‘How are you today?’
Ginny didn’t answer. She hadn’t said a word in three months, now. Given that her dementia was advanced, she’d either forgotten what to say or she couldn’t quite piece together what Toni was saying enough to answer her. But she smiled, and her smile brightened even more when she saw Archie.
This was exactly why Toni had trained her spaniel as a therapy dog. A dog could sometimes get through to someone when a human couldn’t, and could bring a spot of brightness into a sick person’s day. Residents at a nursing home had often had to leave a much-loved pet behind, and the chance to relive happy memories was so good for them. When Toni’s grandmother had been in the nursing home, a visitor with a dog had really helped brighten her mood. Toni desperately wanted to give something back—to help someone the way her grandmother had been helped. And Ginny had been one of her grandmother’s best friends and who’d been like a second grandmother to Toni and Stacey when they’d been growing up; Toni desperately wanted to make a difference to Ginny’s last days.
Archie, once his fluorescent coat was on, went into work mode, being gentle and sweet and sitting perfectly still to let an elderly patient or a young child pet him, suppressing his natural instinct to bounce everywhere. At the nursing home, Toni came to the lounge so all the residents could spend a few minutes with the dog in turn, and it also meant that one of the staff would be present at all times, in accordance with therapy dog visiting rules.
‘Hey, Toni. Hello, Archie, you gorgeous boy.’ Julia, the nursing home manager, came over to them and scratched behind the dog’s ears. ‘Look, Ginny, it’s your favourite visitor.’
Ginny didn’t reply, but she smiled.
‘Catch me in my office on the way out, Toni?’ Julia asked quietly.
‘Sure.’ Toni knew it was Julia’s way of saying that she wanted to talk to her privately about a couple of potential health complications among the residents.
‘Thanks.’ Julia patted her shoulder.
Toni spent a few more minutes with Ginny, letting her stroke the dog and hopefully latch on to happy memories of dogs in her past, then said gently, ‘Ginny, Archie needs to go and visit Ella now. We’ll come back and see you next week. Say “bye”, Arch.’
The dog gave a quiet ‘woof’.
Toni did her usual round in the lounge, chatting with the residents in turn and letting them make a fuss of the dog. At the end of her allotted two hours—the maximum length of time for a therapy dog session—she made a fuss of Archie, said goodbye to the residents and headed for Julia’s office.
The nursing home manager nodded at her drawer, where Toni knew she kept a box of dog treats especially for Archie. ‘May I?’
‘Sure. He’s earned it—plus we’re going for a run on the beach when we leave here, so we’ll burn it off,’ she said with a smile.
Archie, knowing from long experience what was coming, sat beautifully and offered a paw.
Julia grinned, rubbed the top of his head and gave him a treat. ‘I love the fact you visit us on Mondays. It really sets our residents up for the week, not to mention the staff.’
‘He loves it, too,’ Toni said. ‘I assume you wanted to talk to me about a couple of residents?’
‘Yes.’ Julia took three files out of her drawer. ‘I think Liza is brewing a UTI. I did a dipstick test this morning, and although it wasn’t conclusive I’d like to nip any infection in the bud before it becomes full-blown.’
Toni knew that urinary tract infections could cause additional confusion in elderly patients, making dementia worse; and they were more frequent in elderly patients who sometimes refused to drink enough and weren’t that mobile. ‘OK. Do another dipstick test in the morning and let me know the results. I’ll flag it up at the team meeting tomorrow and see what everyone’s schedule looks like. Either I’ll come out tomorrow myself and see them, or I’ll get one of the doctors to come out; we won’t wait until our scheduled weekly visit on Thursday.’ Toni checked the notes. ‘This is potentially her fourth UTI in three months, so I’d like to look at giving her a lower dose of antibiotics long-term as prophylaxis.’ As a nurse practitioner, Toni was able to prescribe antibiotics rather than having to consult one of the GPs, which made life a lot easier.
‘Agreed.’ Julia, as the nursing home manager, was also a qualified geriatric nurse and Toni knew she was good at picking up early signs. ‘And I’m also a bit concerned about Renée. I’ve noticed she has a bit of a tremor when she holds a mug, and she’s been a little bit off with everyone for the last couple of days.’
‘You think her lithium levels might need rebalancing?’ Toni asked, knowing that Renée was bipolar; lithium levels in Renée’s blood needed to be checked regularly, to make sure they weren’t too high and the drug was doing its job properly. A tremor was often one of the first signs of a problem, along with a change in mood.
Julia nodded. ‘Again, I’d like to catch it early if we can.’
‘I’ll take a blood sample now and drop it in to the surgery on my way back,’ Toni said. ‘We’ve missed the bloods pick-up for today, but I’ll pop the sample in the fridge overnight and it’ll go in tomorrow’s batch. We’ll ring you as soon as the results are through.’
‘Thank you.’
She washed her hands, and went to see the charge nurse to pick up a syringe, a plaster, a phial and a label. Renée was a little more scattered than usual and kept wringing her hands. ‘They don’t like me in here, you know,’ she confided. ‘They’re going to tell me to leave.’
Toni knew from experience that when Renée was worried, she’d keep circling back to the same fears and no reassurance would work for longer than a couple of minutes; it just needed a couple of days for her lithium levels to get back in balance and her mood would change and her worries would disappear. So instead Toni gently asked if Renée would mind her taking a blood sample, then after her agreement changed the subject to the weather and how pretty the sunset had been last night.
Thankfully, the distraction worked and she was able to take the sample, then reassured Renée a little more before going to see Julia again to collect Archie.
‘Even before we get the test results, from her behaviour I’m pretty sure you’re right and her lithium levels are out of balance,’ she said. ‘But we need the numbers
