Happy New Year

We have had a family tradition for about the last 20 years (with the exception of 1999) of spending New Year's Eve at Celia's delightful cottage in the wilds of the Derbyshire Peak District. We would drive up on about the 29th or 30th, and see the New Year in with some leisurely walks, nice party food, good wine and a spectacular firework display. If it snowed (and it often did) we would have a lovely trudge over the fields to the pub and have a New Years Day drink in front of a roaring fire. If I was lucky we would be snowed in and I wouldn't be able to make it back to work. As Rosemarie's condition got worse we were more limited in what we could do but the event was still a permanent fixture on the calendar.

Last New Year was Rosemarie's last visit to Derbyshire. I have just been looking at the pictures. Heart-breaking. She could still walk (just) and we could still travel...

I had been thinking for a while about what to do this year. I knew that the Care Home was not going to keep the residents up to see the New Year in, and the two children have their own lives...and I wasn't exactly in a party mood. Celia offered to come down and spend New Year in London, but I thought about it and decided that I needed a break. Apart from a trip to Aldershot for a job interview I had not been out of London for a year. It had been the same routine week after week.

The evening of the day of the medication review I drove up to Derbyshire with mixed feelings. Guilt mostly. My son and daughter were taking turns visiting Rosemarie while I was away, but this was still the first New Year we had been apart since we met.

It turned out ok. Rosemarie seemed on good form, possibly because of the change in medication, and my son and daughter reported relaxed, warm visits with lots of laughter and kissing.

I didn't find the visit to Derbyshire as empty and haunted as I expected. There was enough snow and ice to prevent me driving the car up to the cottage, and fun times were had trying to reverse it round a corner on the afternoon of New Year's Eve, but the snow was gone by New Year's Day.

It wasn't traumatic but it wasn't as relaxing as I had hoped. I probably ate too much and drank too much, and I cannot say that I feel the new year brings hope. I am increasingly feeling a dark emptiness ahead. None of my pictures of my life included this. We were going to spend our later years in warm, loving partnership. Not wealthy maybe, but enough to do those things we never had time to do when work or the children occupied us. Now I look ahead and there is nothing.

I am used to the emptiness and meaninglessness of life (I paid a lot of money many years ago to learn that), and I know that it is my job to create the meaning.

I just don't seem to be able to summon up any interest in doing so.

Medication Review

A bit of catching up to do.

Rosemarie was transferred to Croydon Community Mental Health Team when she was discharged to the Care Home. The assigned nurse has been very supportive and in our last conversation before Christmas I raised the issue of Rosemarie's medication. The basic prescription (Sertraline, Donepezil, Allopurinol) predates her admission to hospital, where they added Clonazepam to control the jerking.  Zopiclone was added by the doctor at the Care Home to help her sleep. Quite a cocktail, and I thought it was time for a review. The jerking seemed to be getting worse, the standing up / sitting down was getting almost manic, and she was regularly upset.

I don't want to disparage her GP, whom I have never met, but then neither has Rosemarie as far as I know. The Care Home has too many residents to be catered for by a single GP practice, so care responsibility is distributed as available and with no particular regard to the speciality of the GP. There is an alarming tendency for GPs (and any other professional) to get stuck in time at the point they finished their training, and I was very glad to find out that - at least for the next few months - a specialist doctor was available from the Community Mental Health Team would be available.

We met at the Care Home on 30th December. Very interesting. The original prescription for Donepezil had specified it should be taken in the morning. The doctor was surprised at this, since apparently it has a tranquilising effect initially then a stimulating effect some twelve hours later. It should be taken in the evening. There was also some evidence that it could be responsible for agitation and depression. He recommended that we start to reduce the dosage in a methodical way and see what effect it had on her behaviour, and then move on to looking at the Sertraline, which could also be contributing to the problems.

He seemed a very intelligent, sensible person and my daughter and I left the meeting generally satisfied and relieved. The only cloud on the horizon was that it was unlikely this level of support would last. 

As part of the continuing break-up of the NHS, the responsibility for Mental Health Care for all Care Home residents has to be transferred to the care of the assigned GP by some date in the spring. 

Her care will then be in the hands of someone with no specialist knowledge at all.  

Strange Days

Christmas Day was strange.

Well Christmas Eve was pretty unusual too. Everything felt out of place and wrong. Nothing to do in the kitchen, no sense of festive cheer, drinking alone...going to bed alone.

Christmas morning felt just like any other day of the past ten months. Unsure how early the care home would be serving dinner we got there about 11.30, driving swiftly through eerily empty streets not yet filling with the midday rush.

Rosemarie was very drowsy when we arrived - medication rather than tiredness I felt. She didn't recognise me or our son and kept closing her eyes and dropping her head to her chest. About midday something seemed to click inside her and she became more alert, seeing us for the first time. By the time dinner arrived she was properly awake and interacting.

The chef at the care home had done an amazing job and the Christmas dinner would not have disgraced a restaurant. The turkey was moist and tasty and there was a selection of vegetables and glass of wine if we wanted it. Rosemarie ate well, seated at the table between my son and me, and seemed cheerful and chatted almost continuously. Christmas pudding and brandy sauce followed and she ate that too. After dinner the care staff handed out Christmas presents to the residents and there was overall a really nice atmosphere.

We took her back to her room to open the presents we had brought for her, and then took her downstairs to the Therapy Room with its light show to relax her a bit.

Both our families had a tradition that everything stops for the Queen's Speech at 3 and as a family we carried this on even though we don't take the broadcast seriously so it was back up to her room for that. She paid it no attention at all.

Afterwards we were planning to take her downstairs again for another change of scene - maybe to the Library where it was quiet and we could have a sing song, but something strange happened: Puss In Boots came on the TV and she became interested. She didn't actually watch it - she hardly notices the screen at all now - but the soundtrack seemed to connect with her. The world-weary or cynical tone of the cat's one-liners seemed to amuse her and she began to laugh a lot. She still never looked at the screen and I do not think she actually understood what was being said (much of it would have been much too fast for her to follow) but she kept laughing at exactly the right time.

By the time the film was over it was nearly supper time (5 o'clock) and we were due at my daughter and son-in-law.

Leaving was every bit as difficult and guilt-sodden as I thought it might be. I think if I had been on my own I would have stayed at least until she was in bed, and probably much later.

I don't actually think she registered that it was Christmas, but the atmosphere definitely got to her and I think she enjoyed it. So did I after a fashion.

I drove away and we spent the evening at my daughter and son-in-law's house with his side of the family (my side would visit Boxing Day). A much more traditional Christmas feeling that felt strangely out of joint to me without Rosemarie there.

I stayed the night and went back to see her Boxing Day. She was tired and quiet and then agitated and tearful. She was not particularly pleased to see me and I felt that the brief glimmer of Christmas was over.

Then back to meet my family - or about half of it. My sister and her partner and children could not make it because she was not well, so it was a bit subdued anyway and I dare say I did not add much energy to the proceedings.

Maybe I will get the hang of it and be better next year. I thought I was at last starting to get some sense of equilibrium, but it feels like I spoke too soon.

As they say, humility is endless.