Tuesday, 9 May 2017

After the break (Part 1)

After the Break  (Part 1)

On 4 November 2011, one week after celebrating her 92nd birthday, Mum broke her ankle. For years, she had refused to use the equipment physiotherapists had recommended for her - Zimmer frames were absolutely not part of Mum's idea of how she could be helped to walk. They were not good for her image as a keen walker - ("I don't need any help!" she would say, "I can walk ten miles a day!") -and she insisted on using a low, four-legged stool for support. She would lean on it, move a step along, then pick up the stool, throw it in front of her a few more inches, before taking another step forward.

On this particular evening, the "accident that was waiting to happen," happened. Her foot got tangled up in one of the legs of the footstool, and she went over, landing on the floor. In one way, it was a relief that it was "only" her  ankle that at that moment was twisted at an impossible angle; we had nightmares about her hip, or shoulder, being fractured.

The ambulance arrived within a few minutes, and the paramedics were terrific. They got Mum loaded into the ambulance and we drove off to hospital with the blue light flashing; they radioed ahead, so there was someone to meet us at A&E.

Strangely, Mum did not seem to be in much pain, but that of course could have been due to the shock of the fall; in fact, we were all in shock at how swiftly what we thought would be a normal evening, had turned into a trip to the hospital, with an unknown outcome to be faced.

Waiting is the worst part, they say; your mind starts racing, turning over every possibility, and your stomach is churning when you think of operations and anaesthetics and the attendant risks for elderly patients. Whenever someone comes near the door of the relatives' waiting room, you are in a constant state of expectation that a doctor might be on his way to talk to you.

Nurses popped in and out to say they were checking on Mum, and taking her to X-ray, etc., so they did their best to reassure us; after about 3 hours, one of the doctors came out to explain what they had done so far.  He said they had not anaesthetised Mum, but she had been very heavily sedated, so that they could manipulate her ankle and get it well supported.

"We are going to admit her on the ward now," he told us, "and your Mum is awake, and quite cheerful. Don't worry; she didn't feel anything, and she won't remember anything we did, either."

When we saw Mum, she was indeed very happy, and chatty! It was such a relief. The doctor went on to say they would keep her in for a few days to monitor how things were going, but there was still a possibility she would have to undergo surgery to have a plate inserted; it was a case of wait and see.

Mum, in spite of what she had just been through, was listening to all of this. Suddenly, very loudly, and very clearly, she said, "I'm NOT having an operation!" and got quite upset - she obviously understood what the doctor meant, and so we all rallied round to soothe her, and explain nothing like that had been decided upon.

Thus mollified, Mum calmed down; we followed her up to the ward and saw her settled in bed. I promised her I would be back, first thing in the morning.

Reassuring Mum like that brought back another, almost forgotten, memory for me.

When I was a little girl, aged 5, I spent a week in hospital in Liverpool, undergoing investigations for persistent tummy trouble - probably a bug I had picked up when we were in East Africa, that had worsened into chronic gastro enteritis.  I remember how frightened I was, being left alone, and Mum had sat by my bed, promising, "I will be back, first thing tomorrow."  These were the years when hospital visiting hours, even for children, were very limited, and strictly adhered to.  Nevertheless, early the next morning, whilst I was feeling especially small and scared, and wondering what tests I was in for, I heard my Mum's voice at the far end of the ward, telling the Sister on duty she had come to see me.

My mother would brook no argument; she made sure she saw me twice a day.  That gave me such confidence, to know that she would be back later on as well, that I was able to bear the long hours  in between.  At 5, I could read, but I think the staff didn't believe I would have liked a book, or something to do! and so fear of the unknown was coupled with boredom.

Being able to tell Mum, at her age of 92, that I would also be back first thing in the morning, made me realise, yet again, that everything we learn in life is never wasted.





 

Thursday, 27 April 2017

Keeping up Mum's fluid intake

Keeping Up Mum's Fluid Intake

Diary note from 1 February 2017

Mum is sipping her tea.

We are doing the usual "rounds" with her, to get her to drink:

"One for Blackie; one for Pushkin; one for Tiddlywinks; one for Wendy's cat, Artist (actually Artemis, but Mum can't pronounce or remember that, so Artist it is); one for Al's pussy cat, Apollo.

Then it's "One for Wendy; one for Al.... etc...."

In between each name and each sip, with her right hand, Mum takes a fresh tissue out of the box to wipe her face. She then puts the tissue under the table and passes it to her left hand, after which she reaches out and puts the tissue in the plastic bag hanging on the door handle.

She is then ready to lift the cup again for the next mouthful.

This slows the drinking down considerably, and the bag is always bulging with tissues.

We try to persuade her to keep just one or two tissues on the table in front of her, that she can re-use at least a couple of times.  On this occasion, she had a collection of several tissues on the table in front of her, and is hanging on to them in between sips of tea.

Half way through one "round" of names, in an effort to distract her, we make a suggestion.

"Now, put both hands round your cup, and hold on to it for a few mouthfuls of tea."

Without batting an eyelid, Mum looks at us and says, "I can't!

"Why not?" we ask.

"I can't pick up the cup like that. I've got tissues in my hand!"

Thursday, 20 April 2017

Surgical Indecision

Back in the day when Mum was still able to consider things fairly rationally, certainly before the millennium, she was in constant pain, to a greater or lesser degree, particularly with her left hip.

She was referred by her Doctor to see an orthopaedic Consultant; she attended all the appointments made for her, and listened very nicely to what was recommended. She would then say "I'll have to think about it....." and another appointment would be made for her.  Invariably, when she returned for the next consultation, Mum would say, "Yes, yes, indeed I will take your good advice.... but there are a couple of things I'd like to get sorted out first, before undergoing surgery."  It all sounded terribly reasonable at the time.

I would pick Mum up from her home in Southsea, and drive her to all the appointments at RN Hospital Haslar in Gosport, but over the years, she never seemed to get any nearer to making a decision to get herself out of pain.

She was clearly frightened of an operation. Her fear wasn't assuaged when the Consultant gave her statistics of having a hip replacement. He told her, "95% of patients do very well. 3% have no improvement, and 2% will have a very poor result."

For Mum, this translated as disaster. She was sensible enough to know that all surgery carries a risk, and that the Consultant had to explain what could happen, but in spite of meeting many other patients in the waiting room at Haslar who had already had a hip replacement, and being told how great it was that they were now pain free and able to walk properly again, Mum could focus only on the 2% disaster scenario. The "glass half-empty" was in full control in  Mum's head.

In the end, as the Consultant had predicted, Mum's hip stopped hurting her; the bones settled in the socket, and she lost a bit of height. However, before that happened, and whilst she was still in pain with her left hip, she started to throw most of her weight onto her right leg; after a while, her right knee began to protest, and cause her even more problems.

She was offered a Zimmer frame and shown how to use it, but preferred to rely instead on a low four legged stool, that she would lean on heavily, then pick up and plonk down a few inches away, before taking a step forward. Her GP always tried to encourage her to use the right walking aids, and explained that using the stool also put put a terrible strain on her back.

The problem was, with Mum sounding so lucid, and definite in her decisions, no-one could argue with her, and we watched with bated breath as Mum made painfully slow progress around the house, clinging stubbornly to the low stool.

One evening, the accident we had all been dreading, happened; Mum took a step forward, got her foot tangled up one of the legs of the stool, and went over onto the floor. One look at her lower leg was enough to show it was serious;  the ambulance was there within minutes, and Mum was taken off to hospital, with a broken ankle.  At 92, we really feared the worst.





Subtle Changes

Subtle Changes

It's only when you look back that you realise how much things have changed. To being with, the downhill trend is almost imperceptible, but then, in a relatively short space of time, it becomes clear that there have been several steps "down," but only a couple of steps back up again.

Since the beginning of 2017, we have had to work at lot harder to get Mum to drink her tea. We have tried a straw (not very easy with tea leaves at the bottom of the cup, until we we swapped loose leaf tea for tea bags), a tommy tippee mug, and finally feeding her the tea on a spoon.

We have to keep reminding her that when her GP has prescribed antibiotics for her, the medicine is always in a suspension, and she takes every dose off a spoon. She manages to get it all down and swallowed in one mouthful, and drinking tea off a spoon is no different. She needs prompting to open her mouth, to keep sitting up straight so the liquid doesn't spill out from the side of her mouth, and then to swallow.  There have been a couple of times when Mum has taken tea off the spoon and then given me big smile and taken a breath in to speak: result - spluttering, coughing and then a sneeze or two until she gets the tea back up.

In fact, when all is going well, using the spoon to help Mum to drink can be quicker than any other method. We start off with a round of the names of all the pussy cats that we know - "one for Blackie, one for Pushkin, on for Tiddlywinks, etc..", followed by the names of our family; each round can be done in less than ten minutes, and maybe 6 or 7 rounds will see every last drop of tea "down the hatch,"so if we allow an hour, that will also give time to have little rests and maybe a bite or two of coconut sponge cake, in between drinks.

There has also been an increase in the wetting of clothes, which necessitates a change of at least Mum's nightie.  If her jumper and cardigan are still dry, that is a bonus.

Back in 2012. when Mum first came home to live with us, it was just one change of clothes in the morning; it was rare for her to have an "accident," or take the pad off, which resulted in her being completely soaking wet (or worse). The bedsheets were changed once a week, on a Friday; an extra set of bedlinen during the week, was required only on rare occasions.

Over time - and especially since about the middle of 2015 - it has gradually got worse, and sheets are now need changing more frequently. We give a silent cheer when the inco sheets have done their job, and the bottom sheet has remained dry.






More of Mum's logic... You couldn't make it up!

More of Mum's Logic... You Couldn't Make It Up!

Scene:

Mum is busy brushing her teeth. Alex waits patiently for her to finish, and makes conversation.

Alex:
Now, when you've finished brushing your teeth, I'll bring you your lovely breakfast.

Mum:
I don't want any breakfast.

Alex:
Why not?!

Mum:
Because I'll be dead,

Alex:
Well, you certainly will be dead if you don't have your cornflakes and a nice cup of tea.

Mum:
I'm on my way out.

Alex:
Well, if you're on your way out, why are you brushing your teeth, then?

Mum:
Well, it's nice to have clean teeth when you're dead.......


Sunday, 26 March 2017

Tea at the Ritz

Mum loves going for Tea at the Ritz.

It's a military operation getting Mum out for the occasion. The timing begins with the first morning call with the carers at 6.30 a.m, when the ladies get her up and washed and dressed and back in her chair, ready for me to take over for the rest of the breakfast shift.

We all pray that everything will go smoothly, with no arguments, and that Mum will co-operate with
getting her teeth brushed and then eating her cornflakes and drinking her tea.  In the mornings, it normally takes about three and a half hours from start to finish, before everything is done, and by then, Mum is ready for her mid-morning nap. So are we!

At about 1.00 p.m., Mum gets up again.  I make her sandwiches (I know, I know; she will have cucumber sandwiches at the Ritz!) but there would not be time for her to eat a proper meal at lunchtime - not with the wheelchair accessible taxi due a couple of hours later.

At 2.30 p..m, with the taxi ordered for 3.00 p.m., we start helping Mum to get changed and into some glad rags suitable for the occasion. If all goes well, that gives us plenty of time, but we always build in some slack in case Mum needs to go to the loo again before we leave.

With pad in place and spares packed in a bag in case of emergencies, we set off from home with one of our lovely drivers.  So far, we have had three gentlemen, and all have been terrifically helpful in making sure Mum is settled comfortably and safely in her wheelchair, and secured in the back of the taxi.

In that position, Mum is sitting up higher than anyone, so she has a good view of everything on the road.  As we get closer, we drive along the Embankment, and Mum notices all the landmarks and all the bridges, and the London Eye.

She has been on the London Eye a couple of times - when she was still able to walk; each time we went, we were blessed with fine weather and I ask her if she can remember going, and the wonderful views we had.

"Oh, it was lovely!"Mum enthuses.  I don't know if she is just being agreeable, but I hope that some of those memories have actually stayed with her.

When we turn into Northumberland Avenue, Mum always asks how much further we have to go; if the traffic is flowing, it's not far to The Ritz.

Our taxi gently glides to a halt outside the Hotel, where the Concierge opens the gate to the inner  courtyard.  We really appreciate the management organising this for us, as we are then all under cover, and it means we can wheel Mum out of the taxi and into the Hotel, without having to worry about whatever the weather may be throwing at us.  As we propel Mum through to the main part of the Ritz, she likes to pause and enjoy looking at all the beautiful jewellery on display in the glass cabinets.

When we are ready to be seated, one of the waiters produces a portable ramp, unrolls it over the marble stairs, and in a few seconds, Mum is wheeled up to the Palm Court.

You can see the look in Mum's eyes, as she takes everything in, in this beautiful setting - the opulent cream coloured Louis XVI style, the panelled mirrors in gilt bronze frames, the flowers, the music, and the sheer elegance of the place, is a treat for us all.

Over the years, we have smoothly slipped in to being regular partakers of tea in the Palm Court, and it is wonderful to see Mum blossom with all the attention she receives. Even though it might not be her birthday on a particular visit, she is always treated royally, and we are happy if it is Mum who receives a birthday cake; she's quite partial to a glass of champagne, too.

The Palm Manager always greets us personally, and makes sure the table is one Mum likes, and where she can see the pianist or harpist playing to entertain the guests.

Mum looks forwards for weeks to each visit. She knows exactly when we are going; for example, in 2016, her birthday on 28 October fell on a Friday. This was not a good day to get the family together, so I booked a table for the following day, on Saturday, 29 October.

In the weeks leading up to the big day, if anyone asked her (and even when they didn't!) what she was doing for her birthday, Mum would announce:

"We're going for Tea at the Ritz soon..... of course my birthday is the day before but Alex has booked up for the Saturday, because everyone can come then."

So some things sink in, and Mum has very clear and lucid understanding about them, including time scale, whom she will see, and she knows how much she is looking forward to the outing.

Whatever else Mum might remember or forget, she always remembers her visits for Tea at the Ritz, and I always think it is one of the best things we can do for Mum.  She looks forwards to the occasion with such pleasure; she enjoys herself thoroughly when we are there, and then she talks about it for weeks afterwards, and is really delighted when we show her photographs that were taken on the day.

I also think these special occasions remind her of a bygone age of elegance; with the Palm Court's beautiful decor, the chandeliers, and crisp tablecloths and silverware, everything contributes to a store of happy memories.  And not just for Mum; but for us, as well.





Friday, 24 March 2017

Bright Spots

Mum asks constantly, "Where are the cats?"

You can give her a straight answer - as long as it is always that the cats are in (she gets really anxious if she thinks they are out), but a moment later, the question comes again:

"Where are the cats?"

"I've just told you, Ma - the cats are in."

"Oh. I didn't hear you."

"That's o.k. Anyway, all the pussy cats are in, and they are snug and warm and they have all been well fed."

"Ah, that's good.  They're good pussy cats."

"Yes, indeed they are. So you don't need to worry about them!"

A minute or two later, the catechism begins again:

"Where are the cats?"

The questions and answers can bat back and forth like a game of badminton, until you decide to toss the question back:

"Now, Ma, what did I just tell you?"

There's a pause for a moment. Then, "Oh, you said the cats are in!"

"That's right! So now you can relax, and know they are all happy and well fed and warm."

"Oh, that's good!"  And sometimes, for half an hour or so, it is.

We know and accept the short term memory loss and, if it's frustrating for us, it must be more frustrating and frightening for Mum, although she doesn't seem particularly upset when she keeps asking us about the cats, and is pretty contented by the constant reassurance.

However, there is one treat that she remains completely lucid about.

Mum loves going for Tea at the Ritz.