Octavia has a new and gorgeous tea cosy. It is ragwork, and beautifully done. If I drank tea, I should be seriously covetous. As it was, I just turned it around so that the ginger cat side was on show, rather than the likeness of the grey ninja.
Thanks to drugs making him dozy, the ginger ninja has spent most of today asleep under a blanket. He had another trip to the vet yesterday afternoon after more trouble peeing. It was a different vet in a different practice. MasterB is now registered with two vet surgeries. This one is open on Saturday afternoons and even on Sundays.
The diagnosis is idiopathic cystitis, meaning the cause is unknown, but this vet, an antipodean like Ellie the Vet, was prepared to rule out cancer. Ellie, knowing me better, would have ruled it out without telling me she had done so. But suddenly I am wondering how short MasterB’s life could be. This vet agreed it might well be stress induced – ie Cookie – hence the opiates to keep MasterB zen. He was very zen at the surgery. Remarkably so. A lot less zen this morning before I had administered a dose of the Metacam, and pretty lively now, and outside swishing his tail. I offered him the chance to come in away from his rather over-assertive girlfriend, but he declined. He seems to prefer to watch her, an Outraged-of-SE17 expression on his whiskers. There may be letters to the feline equivalent of the Daily Mail.
However, I prefer lively to sick, but I can see the timing of the drugs, which he is on for five days, may have to be thought through. Tomorrow he is back at Ellie’s, though I think it is her day off, so he’ll probably see her partner.
As it turns out, MasterB is not the only one close to me requiring medical attention. Aunt has had a suspected heart attack. She called her GP who called an ambulance; spent a day at the hsopital which she found exhausting; and much to her relief was allowed home. She has been told to rest, so I am resisting the temptation to call her every few hours to check up on her. She feels she has lost a lot of ground this year. When I see her next we are going to check out audio books to download to her tablet in case she has to go into hospital again. I have some spare head phones, so she should just be able to close her eyes, shut out all the busyness and bustle, and relax in her own sound bubble.
We had the chance of an extra hour in bed today as the clocks went back in the middle of the night. That’s the end of British Summertime until 2015, and it was dark so early this evening. Suddenly all the Christmas stuff in the shops doesn’t seem so out of place. But it is still mild, so I am hoping the heating will remain off for a few weeks yet.
Slowly catching up on yesterday’s Guardian today, and steadfastly ignoring all the mess and clutter around me, I reached the Review section. Last night I was clumsily trying to articulate how I felt hospitals and care homes put the needs of running the institution above the people in their care. Phrases like ‘care for the individual’ are well meaning claptrap. The individuals have to adapt to the institution; the institution is too inflexible to adapt to the individual.
So you may well imagine how I suddenly sat up straight and almost punched the air when I read this:
The social and medical advances in the 20th century led, in the western world, to the rise of hospitals, which gradually began to admit those with the irremediable problems associated with ageing. Nursing homes were devised specifically to manage this population; as institutions, they have their origins in a medical model of care. “Nursing home” has two words to it, and two aspects, but many prioritise the provision of “nursing” over the creation of a “home”. In his 1961 study Asylums, Erving Goffman noted the shocking similarities between nursing homes and prisons. In common with orphanages, mental hospitals and military barracks, they were “total institutions”, preoccupied with minimising risk and facilitating staff routines at the expense of granting adults autonomy and self-respect. Even now, there are many nursing homes in which clients are not allowed to walk alone in case they fall, eat certain foods they want in case they choke, use knives in case they cut themselves. In many of the institutional homes I visit as a GP, residents are not allowed to keep pets in case those pets inconvenience staff, or bite their owners. As Gawande notes in one of the many poignant passages in this book, we permit children to take more risks than these adults, who are presumably old enough to make their own choices – children at least are allowed to play on climbing frames.
An obsession with risk is stultifying the lives of the most vulnerable in our society, in the years when their choices should be most cherished and respected – even if those choices shorten their lives. We have exalted longevity over what makes life worth living.
You can read the whole review here. It sounds a remarkable, even a wonderful book. With luck it will stir debate; make people think afresh; put life and living above health and safety. Should I ever go into a home, and the chances are fairly high if I achieve old age, I want it to be a home where I can do things; peel the potatoes while I can; sit in a busy kitchen with a cat on my knee and a dog at my feet; choose what and when I want to eat and drink; wear my own clothes that have been washed with care; listen to the music I choose. When Mother was in the Care Home, the phrase that came to mind most often when I saw her was ‘Man cannot live by bread alone’. The lack of mental stimulation, indeed the lack of the idea that mental stimulation for someone living with dementia should be a priority, was depressing and frightening. Those of you who have followed this blog for a while will know my struggles to get staff to read poetry to Mother; to make sure her music was changed (imagine days and days of listening to the same CD); to talk to her; to bring dogs to visit her; in short to see her as an individual with preferences and dislikes, who could experience humour, joy and sadness, whose mind might be made foggy and tattered by this cruel condition, but who was still reachable, still recognisably herself if you worked hard enough to find the points where she still connected.
One carer told me she thought it was undignified for me to remain in the room when my mother was placed on the commode. I thought it was darn sight more undignified for my mother’s nails to be painted with thick silver nail varnish as though she were some sort of doll.
Watching my mother lose her autonomy was very hard, but although dementia is not something I should wish on anyone, I learned to be more fearful of the way she was cared for than of the condition. Being bored to death is more than just an expression, and compassion requires empathy and imagination over rules and staff routines.