Walking Forward, Looking Back

by Dinah Latham

  Ted said that watching Mary deteriorate, as the dementia had progressed, had been like losing her bit by bit. He spoke of unending grief with each backward step she took; each thing she couldn’t do anymore became a loss for him too.

  I was going in to see Mary in the home to be sure she was continuing to settle and also to offer any help to the care staff on her behavioural needs with the experience we had gained over the years while nursing her at home. As I entered her room, she was alone sitting in her own favourite armchair with her head resting in her hands, hiding her eyes. As I sat down next to Mary, I spoke and she raised troubled eyes to look at me. She shook her head slowly for several minutes telling me, “It’s all very confusing… the world’s all upside down.”

  I took her hands in mine and talked about the changes, trying to highlight the things that had stayed the same for her: her breakfast bowl she had on her lap, her favourite cuddly toy that I placed in her hands. But nothing seemed to be working. Mary continued shaking her head and repeating that it was all upside down. I struggled on, not making much progress, when I noticed that Mary was staring, her eyes fixed on her bedside clock with tears beginning to run down her cheeks.

  I too looked at the clock and then exclaimed, “Is it the clock, Mary?” as I hurried to reach and turn the clock over, to turn it the right way up. I then smiled as a look of calm spread over her face and she returned to eating her cereal. The world was all right again for Mary.

  I said goodbye and went to see the carers to commend them on how well Mary had settled in such a short time. I also wanted to share some of Ted’s worries because I knew that these carers, who were so committed to their work here, would also be able to support him when he visited Mary.

  While there are really good care homes like this, where patients live happy, satisfied lives, and where caring, dedicated staff enjoy their work, sadly that isn’t always the case. Residential care homes and care agencies providing care in patients’ own homes both struggle to meet the needs of vulnerable, elderly people. Until, as a society, we decide we want to not only value our elderly but also to value those who care for them, then the quality of care they receive will continue to depend on how much any recipient is able to pay to be helped to the toilet.

  With the predicted rise in the number of people who will suffer from dementia in the coming years, we will need every one of our devoted carers and many more of them.

  8

  HARRIET AND ME

  A lovely walk today. Only two weeks after all the snow and very cold weather, it’s really mild. As we enter Jacob’s Ladder Wood, there is the drumming of a woodpecker right above us. I look and look from all angles round the bottom of the tall tree that I know he must be in. I can hear him so clearly but I can’t manage to catch even a glimpse and Harriet is running back and forth, desperately telling me to move on and watch her carry sticks instead. As we turn left onto the bridleway at the bottom and begin the long trawl, slowly climbing up the slope, there, on the right, I suddenly see the sharp, dark green spikes pushing through the old fallen leaves on the bank – the very beginnings of the wild crow garlic. I can’t be quite sure what it is until I crush two of the baby, spiky, grass-like leaves between my fingers… and, yes, it really is. Last year I looked forward every morning to reaching this bit of the walk; the fragrance of the garlic would greet me before I could see the bank, calling me on with its heady scent, until suddenly, there it was, a mass of tiny white flowers bathed in this glorious perfume, so sweet, so much more gentle than its cultivated brother.

  I love this wood, especially on a really hot day. It’s cool and shaded within. It is said that the steps down – the ladder – were once at the beginning of the garden of Mr. Jacob of ‘cream cracker’ fame. This was all his garden I understand. I silently thank him for sharing it with Harriet and me.

  This time last year, Harriet had struggled to make it up the bank, whereas today she bounds up there, sniffs around in the young shoots and then gallops off to investigate another smell; one much more interesting to her nose than simple wild wood garlic.

  * * *

  I think about this last year with Harriet. I am still amazed at how much a part of my life she has become, just how much joy she brings me and how much we share.

  What has she taught me, this four-legged friend of mine? What are the gifts she has given me? I began to think about her loyalty. I can always count on her welcome. Whether it be when I arrive home or when I return to the car from a shop, her focus will be entirely on me, even when I can’t see her clearly because of the picture painted on the windscreen by the reflection of the trees. Her gaze will not falter. Whatever sort of day I’m having, she will overwhelm me with her enthusiasm; she never fails. As I think about how people change, relationships fail, and friends let you down, she is my constant; my dependable companion. As I grow older and the world moves faster, her quality of steadfast loyalty and trust is humbling. She depends on me to feed her, walk her, care for her and she repays me with her heart and soul – these are my gifts – gifts she gives without measure. These treasures are communicated to me without reserve. What she means she says clearly.

  When I say she never fails, I will always remember when she demonstrated such sensitive understanding of something that was happening to me that even now I am quite moved when I recall the incident. We were away staying with friends for a weekend and I became quite ill – it turned out to be a rip-roaring throat and ear infection but it began with me feeling really feverish. I took the earliest opportunity I could to retire to bed with Harriet sleeping on the floor beside me. I was restless and so very cold, I was shivering, with my teeth constantly chattering, despite hot drinks and more blankets. Finally, I got out of bed and put my tracksuit on over my PJs in an effort to get warm. I was miserable and wretched and feeling very sorry for myself. I wanted to be at home in my own bed and, most of all, I wanted to get warm. If only I could get warm, I could sleep.

  Harriet sat looking up at me for several minutes, her gaze steady and almost enquiring. She then performed her little miracle. She jumped up on the bed, pawed at the bedclothes to pull them back and buried herself under the covers laying right alongside me; pushing close up to my body with her head on the pillow next to mine. The warmth from her body immediately began to soak into mine and as she lay so still and settled, the comfort of this ‘human’ hot water bottle at last brought me sleep.

  Harriet has never, before or since, even stayed on the end of my bed. She jumps onto the floor when I go to bed. She won’t even sleep in any dog bed. She’s never once attempted to get under any covers. But that night she stayed there, never moving, until I got up in the morning and released her. Without delay, she headed for the water bowl and drained it, desperate to slake her thirst before heading out to the garden.

  I’ve heard about dogs that perform enormous feats of bravery for their masters; digging them out of snow drifts, or swimming out and saving a drowning child. I’ve always been in awe of such apparent intuitive abilities. Not for us those dizzy heights for sure, but something almost beyond explanation happened that night; maybe it was simply some duty Harriet, the working dog, felt she had to perform to make things better, perhaps?

  I’ll never know how she knew what I needed or what instinct directed her to do what she did but one thing I do know for certain... she heard what I didn’t say and she answered what I didn’t ask.

  Peter and Paddy

  This memory of what felt like love and care from Harriet to me takes me back to another dog and another occasion.

  I’d been asked to visit a young man in his twenties who had recently had an operation for cancer and had been discharged home from hospital the day before. The GP had asked me to visit to start a course of injections for Peter and had told me that he thought that Peter was living with a girlfriend.

  I arrived at a semi-detached house with two doorbells, indicating there were two flats inside. It was a dull, grey, drizzly morning. Peter opened the door
in his dressing gown. He invited me through a door at the bottom of the stairs leading up to his flat. As I reached the upstairs hallway (in effect the landing), Peter indicated that I needed to mind a rather old, tired looking Labrador lying just inside. I stepped over him and then followed Peter silently down a cold, dingy hallway to the kitchen where he was putting on the kettle.

  We moved into the front room and seated ourselves either side of a wood burning stove set into an old existing fireplace. Burnt out ashes remained in the grate of the stove – there was a cheerless feel throughout and Peter was hardly uttering a word. I was struck by the emptiness. This was a flat clearly being decorated. The wallpaper was half stripped from the walls. It looked like a project in progress; a couple setting up home together.

  However, an air of misery seemed to bounce back at me from all directions. I sat holding my coffee cup on my lap, with a pale-faced Peter barely responding, giving monosyllabic come-backs and leaving my enquiries floating unanswered to the floor.

  As I worked at it, looking in from other angles, trying different approaches, I could see Peter fighting to hold back the tears as he buried his face in his hands. As I moved forward to be close to him, to put my hand on his, the old, very arthritic dog from the hall tottered in and pushed himself between me and Peter, placing a favourite soft toy in his master’s lap. Paddy thought I was the cause of his master’s upset and he’d come to protect him, deliberately putting himself between Peter and me; almost pushing me away. What devotion. Peter and I both smiled, and we got started.

  Peter had presented at the doctor’s surgery with a lump on his shoulder. He had noticed changes in one of his testicles some months previously, but had done nothing about it; he’d let it go, not wanting to go to the doctor with something so personal and private. The lump on his shoulder was a secondary deposit. The cancer had spread.

  He began to tell me that his girlfriend was so angry that he had, as she saw it, cared so little for her, that he had risked everything by not responding to signs and symptoms earlier. He told me that she had refused to visit him in hospital, and when he’d arrived back home yesterday they’d had an angry row and she had packed her bags and left.

  Here was this young man alone, frightened and bewildered, facing an uncertain future and soon to begin a course of gruelling chemotherapy treatment with no close support.

  As we talked, Peter reasoned that the cancer and its treatment was surely sufficient punishment for his failure to attend to the first symptoms of his disease; his rhetorical question hung in the space between us…

  The next three months were hard for Peter but he had a good prognosis and he did well. We had many much easier talks over the following weeks, with Paddy (the dog) never really making friends with me. He would always sit right next to Peter throughout my visit as if to warn me not to upset him again!

  Quite some time later, I did see Peter in the local high street, looking much happier; holding hands with a girlfriend and laughing and chatting. I don’t know whether this was his previous liaison or a new relationship but either way it was good to see life moving forward for him.

  I was very touched to receive a case of twelve bottles of red wine at my retirement party, with a card from Peter saying there was one for every one of the twelve worst weeks of his life, to say thank you for my support. I wasn’t sure that Paddy would have agreed to me being given such a generous gift!

  * * *

  Harriet runs ahead in her usual carefree mood and I lengthen my stride just a bit, realising my feet are wandering like my mind and my pace is only just above a dawdle. All these thoughts about my relationship with Harriet have led me on to think about all those different relationships that happen throughout our lives…

  * * *

  Relationships have always been important to me, whoever they are with; they are what is important in my life. The way we communicate and what is shared between two people, I believe, is the basis of all great friendships (and what is life without those very treasured friendships?). So the qualities of exchange and interaction, I believe, were at the heart of my nursing career, my practice and my lecturing – abilities so often undervalued: the ability to gain access to a patient’s home who needs but doesn’t want you there; the ability to fit in ‘when in Rome’, the ability to motivate nurses with teaching that inspires them to give of themselves, the ability to recognise the essence and value of nursing care, and the ability to ensure the memory of what you say remains with them. This all relies on the ability to communicate well at a real level.

  Harriet is a clear communicator: wag your tail if you like someone, go towards them and lift your paw to touch them; if you don’t like them, growl, back off and bare your teeth! It maybe somewhat simplistic but never are you left in any doubt as to what the dog means. How often do we humans say one thing but our body language or eye contact says something entirely different? How often, when someone is talking to us, are we really listening? Or are we simply waiting for them to stop so that we can have our turn?

  * * *

  Very early, and in the almost pitch black, I’ve finished the New Year’s Eve night shift volunteering at Samaritans; a shift full of heavy duty listening. Harriet greets me as though I’ve been away for at least a month and can’t quite believe it as I reach straight for her lead and ball thrower. No waiting while I do boring things like sinking into a chair – just up and off; great! I fancy that if I sit down the eyelids will instantly close after the long, demanding night. I head for Hervines Park. Feeling that it is just too early and gloomy for woods and footpaths, we road-walk our way there and the darkness does just begin to lift a very little by the time we reach the open ground. The ball is hardly visible as I fling it across the uninhabited football pitch; the only visible signs of life being flashes of white fur as Harriet streaks after it. I get into a monotonous rhythm of throwing, and she responds with chase, fetch, return to my feet, drop and run again… throw, chase, fetch, return, drop and run. This could go on for hours.

  * * *

  My mind returns to my night. There was nothing different from most other nights and yet it was as exceptional as every other night; a night where again I’d been afforded the opportunity of entering into the lives of others. When a caller chooses to share deep feelings, to be able to be alongside in their darkest moments is a privilege to be truly valued, however sorrowful the story.

  Alongside exceptional volunteer colleagues, there is a shared honesty about why we’re there and why we’re supporting each other. Defences fade away in the face of the misery of human experience laid bare. I guess we leave every shift recognising the power of what we’re struggling to do with a heightened awareness of who we are. Juxtaposed with all that suffering, the insignificance of our own problems feels palpable.

  New Year is traditionally a time for reflection for most of us but any thoughts of New Year resolutions just dissolve against this backcloth. Yesterday, I was feeling a bit like Bridget Jones, wanting to record how many calories I’d ingested and what my daily thigh measurement was, together with how many more lines have developed on my face overnight. Added to that, I thought I might decide to paint my toenails more regularly…

  This morning, even this early, before the cold light of day, these trivialities seem so insignificant I’m almost ashamed to have thought them worthy of any consideration.

  How lucky I am to be here with my loyal companion, with a family that cares, with a home to go to and a cup of coffee waiting to be enjoyed.

  My mind unexpectedly makes a connection between my feelings of fortune now and those I often experienced at the end of a day’s work, reviewing my patient visits and finding myself thankful that today wasn’t the day that I had received confirmation myself of a life-threatening diagnosis.

  I’m not quite sure what meaning is held in that connection but clearly, even in a voluntary capacity, I have a need to try to help those in a less good place than I find myself. Maybe it’s simply a need to be needed or perhaps,
more pertinently, I get something from the outcome. It is the payback, the satisfaction I gain from the care I give, that feeds the inner me at quite a profound level. There is also a sense of me paying back, or giving back; the sort of barter system of contribution to society that enables the circle of humanity to keep going.

  I believe that the changes happening in nursing are destroying that job satisfaction: the payback. Towards my retirement, I constantly felt I was involved in less and less direct patient care, staying longer and longer at the computer carrying out management requests – tasks that didn’t serve the patient. Indeed, most often, they just took time and visits away from patients and provided numbers and jobs for increasing layers of management personnel.

  * * *

  Bright, bright sunshine this morning as soon as we set off. The sun is so low in the sky that I’m forced to keep my eyes focused on my shoes. It’s a weak sun with no warmth behind it as yet. I turn off into the wooded part of the walk and the sun shifts to my side. Very often on the early morning walks there are ‘the worker walkers’ – those of the rapid pace; fitting in the dog walk before running for the train and the office. But we’re a band of brothers, those of us out and about while others lie abed; the fellowship of the dawn dog walker. This sense of congregation is heightened when we bump into one another in the darkness of an early, cold, frosty winter morning, or dog leads become entwined as our charges exchange bottom sniffs. We owners get no more intimate than to simply nod to one another in recognition of our hardy, intrepid disposition; comrades against the elements. We greet one another with a fulsome ‘morning’ and even a raised gloved hand. Some are even dressed for a day in the office but with Wellington boots and a cagoule over the smart suit, but more often it’s a pair of baggy tracksuit bottoms pulled on over the pyjamas; a precursor to the shower on returning home.