Category Archives: Dicing with dementia

Bilberries in the hills

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by The Curious Scribbler

Ripe Bilberries ( Vaccinium myrtillus)

August is a rich foraging time and we recently took a break from mushrooming to make a second visit to our favoured Bilberry spot in the Cambrian uplands.

Bilberries (Vaccinium myrtillus) are the much smaller and tarter wild relative of the supermarket Blueberry  (V. corymbosum) a cultivated form of the wild North American species.  When I was a child, blueberries were unknown in British shops and so bilberry picking was a seasonal tradition, the whole family crouched in the heather and scrub, fingers purpling as we picked off the berries, squishing the overripe ones as we picked. It is a tedious task, as few berries are as much as a centimetre in diameter, and while the largest, ripest ones tumble far too easily through one’s fingers, the slightly less ripe ones cling firmly to the bush.  Unless there is a strong breeze, a horde of buzzing flies soon circle around the picker, and horseflies converge from great distances upon a likely blood meal.

But the outcome was a cascade of small spherical fruit baked with sugar and perhaps some apple in a pie topped with shortcrust pastry.  We liked to compare tongues after a bilberry pie, for the purple pigment stains the skin, and a tongue would remain blue for at least a day after the meal. Once you have had a bilberry pie, blueberries will always seem watery and insipid –  a pale imitation of these mountain fruits.

Finding a good Bilberry spot is a matter of luck and close observation.  At best the shrubs grow as loose bushes about 18 inches tall, but often their growth has been accompanied by regrown oak woodland, and they do not fruit freely in the shade.  On sunny hillsides they grow densely with heather (Calluna vulgaris) and form a low growing carpet of green and purple.  Grazing and hill fires both hold back the size of the bushes and the fruit may be smaller and sparser.  Most of the best spots are probably on forestry land where there has been little or no recent grazing but the trees are few.

A sunny hillside of bilberry and heather

Our two man-hours of picking yielded two and a half pounds of fruit which will freeze from fresh into perfect little black spheres of shot.  Neither flavour nor texture is diminished by the freezing process and I will later layer them with bramley apple and sugar in a generous pie.  If half the health benefits attributed to the milder blueberries apply to these wild fruit then we are also protecting ourselves from the ravages of senility, stroke, heart attack  and macular degeneration of the eyes.  And of course the physical exertion of climbing the hill will have also been very good for us!

 

Bilberries ready for the kitchen

Hospital is no place for the old

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I listened to Anne Clwyd MP on the radio the other day, describing the conditions of disinterest and neglect ( like a battery hen)  which marked her husband’s death in hospital in Cardiff.  In the wake of the Mid Staffordshire inquiry, she has been appointed to a government committee to advise on how NHS hospitals should handle complaints.

She has been inundated with correspondence from people from all over the UK whose relatives received little care or compassion on NHS wards. But perhaps most shocking is that while individuals regularly make the same observations, it is widely recognised  among professionals that hospital is no place for the old.

I was responsible for managing my nonagerarian mother’s care and experience in a nursing home in the last five years of her life. About 3 years ago she became severely dehydrated as the result of prolonged diarrhoea.  In need of rehydration the GP assigned her to hospital.

I say assigned because, although the distance was less than a mile it took four hours for her to be admitted.  Those four hours were spent in an ambulance on the tarmac outside A&E, parked alongside three other ambulances containing elderly non-urgent patients.  It was a a freezing cold, brilliantly sunny, January day.  Only two ambulances remained in service, I was told, to deal with emergencies in the entire county!

This part of the care was, however, very good to my mother.  While an IV saline drip cannot (for reasons of arcane regulation)  be provided in a nursing home, she was promptly attached to one in the ambulance.  The heating in the van was excellent, and for nearly four hours she lay quietly rehydrating, attended by the paramedic, the driver, a young care assistant from the care home and myself.  If only, after the four hours, she could have been taken back to her nursing home!

She was at last processed in A&E and eventually admitted to a ward within the target waiting time (not including the ambulance-blocking hours, which do not count towards the target).  It was there that the inadequacies of care became seriously apparent.  Placed in a side ward she was left alone for long periods and not provided with a call bell.  Anti nausea medicine prescribed by the doctor took more than seven hours to appear from the pharmacy.  Simple comforts like tea appeared seldom, ( certainly not on request) while meals were served during “protected mealtimes” when witnessing relatives were banished from the ward. Nursing staff were sullen and uncommunicative.

‘Is she eating anything?’ I asked at the nursing station on my daily visits.

‘Oh we’re very keen on food.’ was the evasive reply.

But evidence there was none.  Full plates were cleared away untouched.  Food and fluid  intake charts were not filled in.  Although quite able to stand my mother was manhandled with a hoist and wheelchair to visit her en suite loo.  No one sought to find out what her physical abilities were. In her own words, she felt she was handled like a piece of meat. Over a week she became more and more deeply miserable.On the sixth day, without explanation, or recording in the notes, she was put onto a glucose drip.  Perhaps they finally noticed she wasn’t eating anything?

Laundry is a reponsibility of the visiting relatives, and on each day I would be provided with a bag of dirties to take home.  Because the reason for her bowel problem remained undiagnosed she was receiving ” barrier nursing”.  How then did the bags I took home prove to contain other patients’ labelled clothing?  When I called to point this out the staff nurse told me that that the two owners of the nightdresses had died, and that I should throw these items away.  A little research proved this to untrue.  One of the ladies was back at my mother’s nursing home, and I eventually returned her freshly laundered nightdress!  I failed to trace the other. But it summed up the attitude on that ward.  Old women with a nursing home tag on their admission bracelet were not seen as individuals.  They were a generic nuisance.

Eventually I wrote a letter to the consultant ( whom I never saw) requesting that she be discharged, whether they knew what was wrong with her or not. I refused permission for invasive tests, which she would have experienced as nothing short of an assault.

In the course of that week I realised then that hospital is just too harsh an environment for a frail nonagenarian.  And that the quality of care is lowest for this category of patient. In her subsequent management I always pointed out to GPs responsible for her care that hospital was not an appropriate destination for the very old.  No one ever disagreed, or suggested that the benefits could outweigh the de-merits of hospital admission.

 

 

 

 

Not enough disability in Aberystwyth?

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by the Curious Scribbler

Another independent shop has closed its doors in Aberystwyth’s picturesque Eastgate Street. The windows, masked in brown paper give it a depressing  air.

Closed shop in Eastgate, Aberystwyth

The now closed Snowdrop Care and Mobility shop in Eastgate Street

However the message posted to the customers gives pause for thought, for it reads “ We would like to thank all our customers for their support and we are sorry there were not enough of you”.

Snowdrop Care and Mobility sold walking aids and wheelchairs, lift-and-recline chairs and beds, mobility scooters, ramps, stair-lifts, continence aids and extra wide footwear for swollen feet.   Not equipment many of us are eager to need. Can we conclude that Aberystwyth’s population is, in the main, ageing more healthily than the commercial predictions suggested?  I hope so.   Certainly there are plenty of the elderly out and about leading busy lives.

Those less fortunate, it is implied (and I hope there are not too many of them) will have to shuffle off to Haverforwest  ( a round trip of 125 miles).   On the other hand they may resort, as we all increasingly do, to doing their shopping on the internet.  I understand that an extensive range of this equipment can be obtained through Lloyds Pharmacy.

Customer told they were insufficiently numerous for the retailer

A reproachful notice to customers of the now-departed shop

Reflections on dementia

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by The Curious Scribbler

My mother was never considered to be suffering from Alzheimer’s disease.  Indeed her death certificate (for she died, a week ago, aged 94) has a slightly farcical ring about it.  Her certified causes of death are Hypertension, Old Age and Memory Loss.  It reads as if she just forgot to go on living.   More likely vascular dementia played a part.  Abnormalities of this sort were detected in a brain scan about seven years ago, and her final years were marked by a number of TIAs (Transient ischaemic attacks) or mini strokes, from which she usually physically recovered, though there were new lapses in memory and ability.

But what is more striking than what she lost is what she retained:  an iron certainty that she was right, and that the only way of doing things was her way.  In my last blog this certainty applied to the control of the items on her overbed table and to her method of achieving quality control on her diet of chocolate buttons.

Here she is five years ago in another white-knuckle account I wrote then:

Shopping for my elderly mother: The quest for the perfect toothbrush                     13 February 2007

I have searched every chemist in town for a small-headed Maclean’s toothbrush like the worn one I have been compelled to carry around in my handbag for the last week.
Eventually I go to the dentists’ and queue to ask if they have any of these toothbrushes (this is where Mummy says they come from, – but because they are no longer on visible display she did not ask for them when she went to the dentist last week). They sell me an OralB small-headed toothbrush which is very similar to the Maclean’s one. The assistant has worked there for eight years. She is quite definite that they have never sold Maclean’s toothbrushes.

I took the toothbrush round to my mother and handed it to her.
She gazed at it and laughed merrily.  “Ha,Ha, ha, ha, ha, ha.” She chuckled.

 I couldn’t muster such a cheerful peal however hard I tried.
She drew breath and laughed again.
“What,” I asked calmly “is so funny about it?”
“Oh, I’ve never seen one like it!” she replied.

I point out its similarity to her present Maclean’s tooth brush, which I fetch from upstairs. The small head is exactly the same size. The handle has one blue flash rather than three diagonal stripes. The handle, she says is very long. She has never seen such a long toothbrush.

I hold them side by side:  once you subtract the packaging, the two toothbrushes are exactly the same length.
So now we come to the bristles. This new toothbrush has the tufts of bristles cut on a slight diagonal so that they are longer at the front. The toothbrush she has just started using has them cut square. The manky brown-stained ex-toothbrush in my handbag has alternate pairs of long and short tufts.

But I can tell, it is not, and never will be, satisfactory. I tell her that the assistant at the Dentists’ says that they never did stock Maclean’s toothbrushes. She shakes her head emphatically with a knowing grin. She knows when she is being told a whopper.

 ***********

Was this a symptom of dementia?  Or was she just being herself?

 

A Degree of Dementia

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by The Curious Scribbler

She is awake in her chair and watching the TV.  The sound is off.  If it were on she would not hear it.  She is deaf.

On her table is a substantial stack of broken fragments of chocolate buttons.  There is also a pool of tea.  The lipstick which always props up the chocolate-smeared emery board is particularly heavily smeared with chocolate.

I tackle the problem.

“You look in a bit of a mess here,” I say.  I point to the buttons.  “Do you want these?”

“No,” she replies, “they are old ones.”

“They are only broken” I say, “You are throwing away perfectly good chocolate.”  But I collect a paper towel from the bathroom and clear up the heap of mauled chocolate.  I wash the lipstick case in warm water and return it to its place.  She seems accepting rather than grateful.

The situation is worse than I thought.  A layer of milky tea has spread across the table, soaking under the lizard from Lanzarote, the Chinese serpentine frog on a lily-pad, the birthday cards from me and from my sister-in-law.  I pick each up and wash the table with more paper towels.  A j-cloth would be handy but Health and Safety regulations in the Nursing Home determine that only disposable materials may be used for cleaning by us amateurs, the relatives.  We don’t even have the use of a drying up cloth or a washing up brush in the kitchen for fear we might spread contamination.  As a result all the personally owned mugs become rimed with tannins, brownish in their crevices.

The tea on her table derives from my mother’s obsession with placing her empty mug on its side when it is finished, or in her words “dead”.  It is not invariably completely empty when she makes this decision.

As I clean I pause to speak distinctly and slowly in her ear.  “This- happens- because- you- insist-on putting- your -mug -down-on-it’s-side.”  I say.  She hears the words.  “Possibly,” she replies, “ but I have found that it is best this way.”

When I am done, I water the flowers, restock her mini fridge with six packets of Cadbury’s Giant Chocolate Buttons, and her cupboard with three bottles of Maple Syrup.  Dementia likes sweet flavours.   She has long taken maple syrup on her porridge. Now she demands it on her soup and pureed meals as well.  One of the nurses is pregnant, nauseous, and cannot bear to feed my mother this mixture.   She delegates lunch and supper feeding to other carers.

Poor old lady you think, unable to feed herself.  But she is able. She simply elects not to.  That is what the carers are there for.

Her room tidied, I sit down on the bed beside her.  My gorge rises.  There on the table is a new stack of nine or ten chocolate button fragments.  With her right thumbnail she is deftly prizing two fused chocolate buttons apart and discarding the pieces.  Little wonder many are stuck together.  All day she sits with the bag tucked down beside her thigh.  The buttons become warm. They stick together.  She refuses to have them placed on a plate or little bowl on her table.

“You-are-breaking-your-buttons-again.” I state clearly.

“Yes, these are not suitable ones,” she replies, “they are old.  I must throw them away.”

There is a response on the tip of my tongue.  But I confine myself to telling her that she would never have allowed a child to waste food in this way.  I, as a child, was not allowed to leave the table until I had eaten everything on my plate. “Waste is anathema to me.” she used to say.

She is unmoved by my reasoning.  I am not sure that she remembers what a child is.  I firmly suggest putting the buttons back in the fridge for a while so they will become firm again.

With dignity and force, she refuses. “No,” she says.  “ I find it works better this way.”

Cadbury's Giant Chocolate Buttons

Cadbury’s Giant Chocolate Buttons