Walking Forward, Looking Back

by Dinah Latham

  I had just left them all in the barn lounge as I called Harriet and announced we were going up to our allotted field of sheep to have another session. As I was putting on my boots outside the door, I heard one of them saying:

  “Did either of you know Mum harboured these latent aspirations to be involved with all this countryside sheep stuff?”

  Amid peals of laughter came the immediate response in chorus: “No!”

  No, I didn’t know either, I thought, and I grinned to myself as Harriet and I walked off up the drive to our sheep. I have got fantastic kids who not only come on this sort of holiday with me but who have, together, bought it for me for a birthday present. How thoughtful and generous is that? Particularly when I recall how Izzie, when she moved to a new job recently, resolutely refused to look at anything to rent that wasn’t within easy reach of an all-night supermarket! I think, perhaps, they may all be city dwellers at heart, and yet here they are, with me, way out in the countryside.

  We’re staying in a beautifully converted, five-star, self-catering barn on a sheep farm in Lancashire. It’s turning out to be my ideal holiday. I’ve never been a ‘laying-on-the-beach-going-golden-brown’ girl myself, primarily because I burn and freckle as soon as the sun shows itself and I seem to have spent most good summers smothered in factor fifty sun cream and hiding in the shade. Here, still with the factor fifty, over a warm Easter, Harriet and I have been given a field of our own for the week… a field with its own sheep that we can pretend are ours and visit as many times a day as we choose, practising the skills we’re struggling to learn. We’re being helped by a sheepdog trainer of considerable note and I feel privileged that he’s been prepared to give us his time and patience, let alone loan us his sheep. I’m not sure Harriet considers it a privilege. She shot him a look this morning that said, “Who are you in my field? Just move aside and let me get to the sheep.” It was amazing to see how quickly she reacted to his presence though and how soon she realised that here was someone who really did know what he was doing and who could read the sheep as well as her… well, nearly anyway. She seemed to be thinking “Hello… p’raps I’d better listen here. ‘He who must be obeyed’ has spoken.” I’m sure she went on to hope he could teach me something too. Indeed, I swear that snort as she shook her head was a disguised laugh as she heard him telling me: “Let her go. She can do it. Have confidence in her.”

  I’m loving the whole feel of the farm life. While country life has moved on from the village life I experienced as a child, there is still a feeling of space, and somehow the seasons appear to hold more meaning for those who live here than they do for city folks. Their lives have an altered base. We’re just past the bulk of lambing here, with all its sense of spring and new beginnings, and with it the suggestion of long hours and hard work that it entails. It’s as though the vital points of reference here in the countryside are distinctly different from those in the more materially founded urban areas of home. Maybe it’s a harder life than we part-time visitors understand. I look at the collection of Border Collie dogs living at the farm. They are kennelled outside in all weathers and they all bark as we pass. Well cared for yes, but they’re appreciated as working dogs; not pets. Not for them central heating, a warm soft bed or marmite crusts for tea. It’s a sense not exactly of hardship that’s reflected in the community life around, more a sense of reality juxtaposed with these seasons; maybe it’s the struggle with the elements and an existence with less control over what life chooses to deliver. There’s a truth here, where, in some ways, fortitude and resilience replace sentimentality.

  Well, I think we both came back with more confidence and a determination to return; to look out again at the views, rolling hills covered with sheep and gambolling lambs. Harriet curls up on the sofa next to me, as I wonder how much progress we can make before we return. “Maybe I can get you fully onto the whistle by then,” I murmur. “Maybe we could even manage to pen some sheep. Last time we tried that I seem to remember you thought you’d drive me into the pen and leave the sheep circling outside. What was it our trainer said? ‘Well, Rome wasn’t built in a day’!”

  * * *

  Both Harriet and I definitely need our confidence this morning. We’re back home but have been given an opportunity to work two-hundred sheep in a sixty-acre field just a few miles away.

  I’m still on an absolute high and can’t quite come down from those giddy heights: sending Harriet way out on an outrun, probably the longest she’s managed. It wasn’t perfect but it wasn’t too bad either. She didn’t plough through the middle, which I dreaded she might, and she didn’t cross in front of them either. She went round on the flank I gave her, gathered all two-hundred sheep and brought them down the field to me… somewhat faster than she should, but she did it. While she went down the hefty bank with them, out of view, about five-hundred yards from me, my heart was in my mouth waiting for the sheep to come up into view. Where were the sheep? Where was Harriet? Then, slowly, (it was quite a steep hill) a long row of little white heads bobbed above the eye-line, followed by sheep and more sheep, and behind them all was my very own sheepdog flanking from right to left keeping them together. It’s a picture in my mind that I’ll hold onto forever. I gave her a stop command as the sheep came frighteningly fast towards me. This allowed the sheep to settle down somewhat, while I flanked her to her left and tried to get her to walk them across in front of me; all the while, I struggled to read the signals she was giving me about the sheep and where they were heading.

  My heart rate settles along with those of the sheep. There was a scary moment there when a headstone loomed large in my mind’s eye with ‘trampled to death by eight-hundred cloven hooves’ written across it.

  I call her off with a “That’ll do” and stroke her gently on her head, as she lifts her nose up to look at me, clearly pleased with herself. I know she’s saying, “Didn’t I do well?” Both she and I are on cloud nine, unable to believe we’ve done it together. We’re both exhausted too and she has good reason for that; she’s run a long way. My tiredness is the result of recovering from the excitement.

  Inwardly, I thank her for showing me how to help her carry out the whole manoeuvre. As we walk to the gate, I reflect on the fact that, yes, it is indeed her teaching me, and I begin to think how often patients themselves were my teachers…

  * * *

  Marguerite

  When I had first visited Marguerite, her gruesome diagnosis had been immediately obvious. After struggling to open the door to me, using both her hands to exert the pull she needed, her head was bowed down onto her chest, eyes on the floor and she had then placed both hands firmly on her forehead and pushed her head up to see who I was. I had been asked by the GP to visit this sixty-year-old lady as soon as possible as she had recently been told she had motor neurone disease (MND).

  This life-limiting, progressive, degenerative disease leads to weakness and wasting of muscles, causing increasing lack of mobility in the limbs, and difficulties with speech, swallowing and breathing. There is currently no treatment that will halt the progress of the disease. The body continues to become weaker, while the intellect remains unaffected. In Marguerite’s case, her neck muscles were affected as one of the early presenting signs of the disease… somewhat unusually in my experience.

  * * *

  Within a very few weeks, Marguerite could only shuffle slowly with help, from bed to chair, where Charlie, her beloved cat, sat waiting for her to be positioned. She was unable to speak, using her right thumb up or down to signify yes or no, while her flaccid, lifeless arm was supported along one arm of the chair. Now, she was unable to hold her head up at all and I would position a folded scarf across her forehead and secure it around the headrest of her chair.

  Opposite her chair, on the other side of the fireplace, was another chair; an all-singing-all-dancing chair that would go up and down, back and forwards, at the touch of a button. On said chair lay a metal back brace, to which was attached a neck stem with a h
alo band attached to its upper end. This was some of the equipment provided by the physiotherapist. Marguerite was supposed to wear and use these daily but she steadfastly refused. She hated the halo contraption that was intended to grip and support her head. We ‘discussed’ my concerns that, should my improvised scarf head support fail, there was a danger of her head falling very heavily forward, carrying with it the very real possibility of breaking her neck. Marguerite chose to accept this risk and held fast to her decision.

  She could manage to stroke Charlie as he had learned to sit on the arm of her old chair within reach of her one thumb and the arms of the clever chair weren’t wide enough for him. We both came to dread the well-intentioned visits from the physiotherapist who kept writing notes admonishing us both for not using her apparatus.

  I obtained an adapted word processor, a ‘lite’ writer, through the speech therapy department, that would have enabled Marguerite to punch messages on to a screen with her thumb. She dismissed this too. I managed to develop a way of communicating using a tin tray and children’s magnetic alphabet letters that Marguerite could just move with her one thumb. It was then I discovered that she had been an extremely able, high-speed typist prior to her illness, and found the laborious typing on the word processor just too awful, reminding her constantly of the abilities she had lost. She shared with me, using the letters on the tin tray, the mental anguish it caused her. From then on this was the way we communicated, the way we shared our thoughts, and I learned what was important to Marguerite. It was hardly high tech but it worked.

  As I dried her tears, I mopped the incessant drool that escaped from Marguerite’s mouth. As the muscle weakness intensified, it became increasingly difficult for her to even swallow her own saliva. This intelligent lady, trapped in a failing body, struggled to make some sense of what was happening to her and, to the end, fought to make her own decisions. I got to know her well over the months of her illness and, while it often presented us with problems, I think Marguerite’s refusal to conform was something I admired about her. I missed ‘talking’ with her on our tin tray when she died.

  In one of the last ‘tin tray conversations’ I had with Marguerite, I had asked her what things we, the district nurses, had done for her over these months that she felt had helped her and what else she would have liked us to have done. Laboriously, she moved the childish letters. Finally the message read:

  ‘You nursed me, not my disease…’

  Our patients are our teachers only if we take the time to listen to them; and only if we really listen, rather than half listen while actually planning what we want to say next.

  Even as I’m thinking about Marguerite and how much there is to learn from what patients say to us, my thoughts gallop forward to a time when the learning I needed came by way of a patient’s actions, rather than her words.

  Phyllis

  The Matron of our local cottage hospital (I believe ‘lead nurse’ is the term used now) had asked to see me about a patient they had who wanted to be discharged home and thus would then have been under my care. So often these small local cottage hospitals were loved and prized by patients who had great attachment and loyalty to ‘their hospital’, where the standard of nursing care was often second to none and where there was continuity of care between hospital and community staff. They also enabled relatives to visit easily, easing the fear and loneliness of illness and disease. They were serviced by the local GPs and therefore hospital and community staff frequently worked closely together delivering care to the surrounding locality.

  These centres of excellence are almost non-existent now; closed down by health authorities who have as their mantra ‘bigger must be better’ and who seem to be able to convince themselves that patients need to travel as far away as possible from their homes when they need an operation. They appear to believe that patients are so desirous of change that they want to go to a town and surgical team they’ve never heard of, where relatives can’t afford either the time or the hospital parking fees to visit, and where public transport is infrequent and inconvenient.

  I went into Matron’s office at lunchtime and we had a cup of coffee while she talked to me about Phyllis. Phyllis had been admitted by ambulance some three weeks earlier, unconscious and generally in a very poor state of health, having fallen down the stone steps in her back garden. Apart from her head wound, Phyllis had a large, macerated area on her right buttock, where a neglected cancerous tumour from the lower bowel had broken through and was now just an infected, ulcerating cavity involving most of the buttock tissue. Phyllis had arrived on the ward with several old towels covering the area and held in place by her knickers.

  Matron went on to explain that the ambulance men felt that her home was not fit to discharge Phyllis to. The house was in a very dilapidated state with many broken windows, only one (cold) tap in use, and with no heat or light due to the electricity having been cut off because of non-payment of bills. There had also been a water leak at some time that had rotted several of the stair treads, leaving no access to the upstairs. Phyllis had been living in the sitting room and sleeping on the sofa for a long time.

  I gathered that Phyllis was causing considerable havoc while on the ward, with her continual loud insistence that she wanted to go home. She was an alcoholic and, whilst she really wanted the pain medication she was receiving in hospital, she also wanted alcohol and had become quite challenging during her stay.

  “I’ve got to get back to feed my cat,” she told me.

  I made a pact with Phyllis that if she would stay in hospital until I could get a couple of windows mended and the electricity turned back on, I would see the cat was fed, and she could then come home if she still wanted to. Eventually, her neighbours reluctantly agreed to feed the cat, although they admitted to being somewhat fed up with Phyllis throwing her empty bottles over the fence during her drunken episodes.

  With the help of a few charitable bodies, we were able to get light and heat, making Phyllis’s room suitable for her to come home to. I’d actually even managed, with considerable difficulty, to arrange for a hospital bed to be erected in her room, to avoid her having to sleep on the old, somewhat damp sofa.

  Phyllis was fully aware that the cancer couldn’t be cured and that her life expectancy was very limited, and we talked about the possibility of sudden haemorrhage and of her dying at home alone. She said she knew that would happen but stated that if she wanted to go home to die and not to stay in hospital then it was her choice and we should stop interfering. She was right. What authority had we to judge how she should live? Or die? Phyllis was discharged home, agreeing to daily visits from the district nurses to dress her tumour wounds.

  It was raining the following day when I made my visit. As I pulled up outside the house, there, on the front path, was my precious hospital bed, complete with a very sodden mattress covered in puddles.

  “If I’d wanted a proper bed, I’d uv asked for one. Since you wanted the bed, you can bloomin’ well ‘av’ it. Take it away with you!” Phyllis said.

  Phyllis’s husband had died several years previously and listening to her talk about him, it was obvious that her drinking had, in her words, ‘got out of hand after he went’. She still missed him dreadfully and would play Victor Sylvester records on her battered old record player, remembering the times they had danced to those tunes together.

  She did die alone, on her old sofa as she’d wanted, and I learned to think again before deciding what I felt was best for patients, and maybe to hesitate and consider who it was for, who really wanted or needed it, before I made my decisions.

  * * *

  We’re out on an early evening walk. It’s not too cold, although we had a warmer spell in March than it’s managing to give us now at the end of April. We’ve found another footpath that we’re busy investigating and we’ve come across a small field of ewes with their lambs. I can’t resist stopping to watch. There’s a timeless feeling of lambs and spring, rather like the ebb and flow
of the tide; whatever may befall us, these simple joys will always be here, year in and year out. The distant sound of church bells calling the community to church and evensong somehow authenticates the rural scene.

  * * *

  As I’m leaning on the fence watching this display of gambolling lambs and peacefully grazing ewes, listening to the bell peals, I find myself smiling as I remember last week’s handbell ringing practise; in itself, a sort of country pursuit I suppose. While it’s not extinct within town communities, I’ve always suspected that there are more small handbell ringing groups in country villages; like the one I belong to. Indeed, we have a local bell festival each year, where several handbell ringing groups from several surrounding parishes meet and play for one another; always a fun occasion, with lots of chat and sharing of ideas and music. I’ve been a handbell ringer for quite a number of years and am still taken aback by how special it is to make music together. I’ve often wished Mum had lived to hear me play bells; her talent for playing the piano had not been inherited by either her daughters or her grandchildren and she so loved her music. I think she might have loved mine too.

  At our recent practice I just couldn’t resist smiling as we turned to the first piece of music and prepared to play…

  ‘Sheep may Safely Graze’ was there; displayed in all its glory.

  Not while Harriet’s around, I thought.

  Could we, Harriet and I, one day gather all those grazing ewes with such a good outrun, such a steady considered lift and fetch, that even Handel might approve?

  * * *

  We’ve come out early this morning for our walk. We’re early because it’s the first day of our long weekend in Cornwall. Harriet and I now stand up on the edge of the sand dunes as they creep up the craggy bank, just before the terrain becomes rougher, the grass tougher and well-trodden footpaths push their way through the brambles and bracken.