203. How do You Know?

Recently, there seem to have been a lot of news features on television about older men suffering from dementia.  As I am now well entrenched in the ‘old age’ category of the population, becoming demented is something I think about now and then.

Quite how old I am was forced into my consciousness this afternoon when, completing a survey from The Stables, a nearby music venue, I was asked to indicate my age by putting a tick next to the right category.

How insensitive of them.  I was given 14 rows to peruse with the first being 0-14 and the last was 75+.  Why have groups of 5 and not 10 years?  

36-45 would be much more sympathetic than 36-40 followed by 41-45.  Then, I would have put my tick in the eighth row and not the fourteenth.  It would still have been at the bottom of course, but at the bottom of a much smaller tower.  It wouldn’t have made me feel and appear quite so ancient.  Incidentally, the final age group on the NHS website is 91+.  That’s more like it.

Every day for the past 20 years or so, I have completed a Sudoku puzzle rated “Super Fiendish”.  At first, I did them because I enjoyed the challenge but recently, while doing one I keep thinking something like, “This must be helping to put off dementia.”

There is a timer on the screen ticking away as I do the puzzle.  I don’t know why it’s there and I never used to pay any attention to the time it took me to complete a puzzle but nowadays, I do keep an eye on the clock.  Today, it took me 37 minutes and that is worryingly slower than usual, especially as Caroline rattled it off in 9 minutes.

This brain damage business reminds me of something that happened ten years ago.  We were in France on holiday with Caroline’s sister and her family.  Oscar, Joanna’s elder son, who was 12 years old at the time, was playing around on the roof of a shed.  He slipped and fell, landing on his head and was unconscious for a short time.

As soon as he came round, the questioning began to see if he was OK.  

“Where are we?” asked his mother.  

“Talais in France.”

“What day is it?” Caroline asked him.  

“Thursday.”

“Say pi,” said Timo, Oscar’s ten-year-old brother. 

“3.1415926535897” Oscar began.

“OK, that will do,” interrupted his Mum.  “You’re fine.”

“93238462” 

“Stop now.”  

“64338327950288”

“Stop it!” bellowed his Mother.

“197, but I used to know the first five hundred,” Oscar mumbled, almost tearfully.

In 2008, when I was in Broward Hospital in Fort Lauderdale, Florida, recovering from my liver transplant, I was asked questions by a doctor I had never seen before to find out how my brain was coping after weeks in Intensive Care.  I can still remember three of the questions I was asked. 

“Who was the last left-handed President?”

“Sorry, I’ve no idea.”

“Who’s in charge of The Department of Education?”  

“Ed Balls, I think.” 

“What state are you in?”

“Very ill, I suppose.”  

I don’t know if that doctor knew I was English and not American.  If he didn’t, I expect he thought I was showing signs of dementia.

144. The secret of a good memory is to forget the trivial

Shortly after we moved from North London to Wavendon, I drove, for the first time, along a country lane about a quarter of a mile from our house.  I was in a bit of a hurry but as the lane is narrow and bumpy, I was only doing about 15 miles an hour.

As I rounded a bend, I saw a pretty cottage on the left but what grabbed my attention was the sight of an owl perched on the roof.  I stopped and stared.  This was not the kind of thing one ever saw in London.  

The owl just stared back at me while I took out my phone and took a photo through the rain-spattered windscreen.  

I would have liked to have stayed longer and watch as it flew off but I was late, and so I drove on.  A month later, I drove down that lane again but this time, with Caroline.  

“Do you remember that photo of an owl I showed you?  It was along here somewhere that I saw it.  Just round this bend, I think.”  I slowed down.

“Oh……. It’s there again.  It must have a nest nearby.”

After a short time, Caroline started laughing and suddenly, I was feeling a bit silly.  

“Stop it,” I said.  “But you’ve got to admit it looks very realistic, doesn’t it?”   

“No, not really,” she sniggered.  “I think you may be starting to lose it.”

*******

Caroline’s car seems to have a leaky tyre valve or a slow puncture.  She has had to add air to the same tyre three times in the past month.  The warning symbol was showing as we pulled into a garage this morning to get petrol.

“I know what will save time,” I said.  “You fill it up with petrol while I go and check the air pressure…….”

*******

We bought an ‘intelligent heating control system’ recently.  When it is first installed, it learns your temperature preferences and requirements over the course of a few days as it memorises how the thermostat was set and when the heating was on or off.  The boiler is then left on constant and the house will be at the temperature you need 24/7.

Ramble:

24/7!  I hate that expression and I’m irritated by people who use it instead of “continuously” or “always” almost as much as I scorn those who talk about “back in the day” instead of “in the past” or “once”.  As for those people who preface almost every remark with “Yes, but at the end of the day…,” words fail me.

 I heard this wonderful exchange during a news broadcast in November 2013.  The BBC had sent a reporter and a camera crew to the HQ of the British Red Cross, to cover the collection and organisation of materials to send to The Philippines where Typhoon Haiyan had caused widespread destruction.

Interviewer: Long hours, difficult job?

John Cunningham (Red Cross manager): Yes, we’re doing about 18 hours a day, 24/7.

Something that really got on my nerves was the reporting of the results of the local elections.  Seats no longer just changed hands and parties did not seem to win or lose seats.  

Today, it seems, a party will “sweep to power” if seats are gained or they are “wiped out” if seats are lost.  When and why did politics become so aggressive, unpleasant and antagonistic?  Every issue appears to bring about an extreme polarisation of opinion.  

Anyway, back to our new heating system: What makes our new heating control system different from an ordinary thermostat is that I can alter the setting when I am away by using an app on my phone. 

We spent some time in Yorkshire in March.  Before we left home to drive up the M1, I had set the temperature to only 5°C which meant that even though the boiler was on constant, it would not fire up and so the heating would stay off unless the temperature fell below five.

A few days later, driving home in a blizzard, I checked the app on my phone and saw that the ambient temperature in our house was 11°C.  I turned the thermostat up to 22°C using the app and so, when we arrived two hours later, we walked into a warm, cosy home. (In case you are wondering or even outraged, Caroline was driving.)

The weekend of April 21st and 22nd was hot and the house temperature never dropped below 20°C.  Consequently, I dropped the thermostat setting by ten degrees and hoped that was the last time we would need the central heating until October.

But I was wrong.  On the following Thursday afternoon, I was cold and I reached for my phone to access the app but I couldn’t.  The phone was dead.  I wasn’t too surprised because it is more than three years old and recently, the battery has been losing charge very rapidly.  It had finally died.

I’ve been receiving text messages from Carphone Warehouse for several months telling me that I’m due a phone update and it seemed that this was the right time to do it.

I walked into the store, put the phone on to the counter and told the assistant why I was there.  He disappeared into the back and when he reappeared, he brought a new phone and went through the paperwork with me.  

“Would you like me to transfer all the data for you,” he asked.  

“Yes, but you’ll need to plug it in please because as I told you, it’s dead.”

He got a cable and connected it to the phone.  Ten seconds later, he looked at me and said,

“You know it’s turned off?”  

I realised instantly what had happened.  The previous night, I had been woken at three in the morning by my phone vibrating when an email came through.  To stop that happening again, I had switched it off and then I forgot to turn it on again in the morning.

I’m reminded of the time about six years ago when a friend rang and asked if I had read the email he sent.  

“I’m not sure,” I said.  “I may have done.  What was it about?”

“It was a test to see if you are likely to get Alzheimer’s.”

Do both dementia and Alzheimer’s disease arrive so slowly, surreptitiously and stealthily that, when someone is eventually told that they have one or the other, that information fails to register with them because they are so far gone?  

Or, is there a time when people who suffer from early stage dementia or Alzheimer’s realise that they are in the early stages of that condition and are able to react accordingly?  

I have no idea what the appropriate response to that news would be and so I hope that I’m just a bit forgetful at times.

86. Nurses - Much more than just Carers

I spent last Wednesday night in hospital.  The only time I’ve been in hospital before was in Fort Lauderdale, Florida when I was in for 3 months following my transplant.

Here is a brief history of one of the most interesting 36-hour periods I’ve ever had in my life:

Wednesday
2:00 am	I get out of bed and have to stop to rest three times walking the 20 paces to the bathroom because I am so breathless.  I am coughing up buckets of phlegm, I’m hot and I feel terrible.
10:30 am	Caroline insists that I visit the doctor but I am so weak and tired that I tell her I can’t.  She phones the surgery.
12:30 pm	The doctor arrives for a HOME VISIT!!!   My temperature is 39.7°C, my blood pressure is 71/47 and my oxygen level is 86%. Very quickly, I am diagnosed to be suffering from pneumonia.
3:00 pm	I am admitted to Milton Keynes hospital and go through an hour of tests and x-rays.
4:00 pm	I go to a ward in the MAU (Medical Assessment Unit).  All the medical wards are full.  There are 3 beds on either side of it. 4 men, two of whom are younger than me, occupy the other beds.  There is one empty bed. 1 On the far side of the ward, to my left, is John.  He looks very old and is either asleep or unconscious. 2 Directly opposite me is Peter (possibly 35) who is sitting up in bed, staring intently at me with both his hands shaking on his lap. 3 To his left is a middle-aged man reading a magazine. 4 To my right is an old man who is lying on his back and staring at the ceiling. The bed to my left is vacant.
4:45 pm	Peter, who has been staring at me most of the time, speaks to me: “Got a cigarette?”  I shake my head.
6:00 pm	John gets out of bed, shouts and starts to walk, very unsteadily, away from it.  The nurses try to get him to return but he ignores them and sits on the bed of the Magazine Man who has been taken to X-Ray.  John is shouting continuously.
6:30 pm	Magazine Man is back from X-Ray and tells John in no uncertain terms to, “Get off my fucking bed”. Eventually, John does that and walks towards his own bed.  At the last moment though, he evades the nurse shepherding him and goes to stand by the large open window.  As the nurse walks towards him, John raises his fists and tells her to, “Fuck off,” or he’ll hurt her.  She stops for a moment and then moves towards him.  John swings a fist at her but misses.
6:45 pm	Dinner is served.  I just have orange juice, as I’m not at all hungry.  John refuses anything brought to him and Peter says he’s not hungry but he wants a, “very big vodka.” “How am I supposed to stop my hands shaking?” he asks the nurse.  “Get me a drink.”
7:30 pm	I notice that John is standing in a large puddle on the floor.  Two new nurses, who have just started their shift, try to get him to move so they can clean up.  He refuses to move and shouts, “I’m 83.  I was in the army and fought the Germans.  I’m not frightened of you two.” The man to my right shouts out, “To pee or not to pee?” and laughs loudly at his joke.
8:00 pm	I try to be helpful. “If he’s 83, he was only 15 when the war ended,” I tell the nurse, “and so he couldn’t have fought the Germans.” The nurse says, “Thanks,” but rather coldly.
8:30 pm	John removes his wet pyjama trousers and stands by the window, stark naked, shouting at the top of his voice.  The nurse hands him a urine bottle. “It’s empty,” says John, looking aggrieved. The nurse tries to explain what the bottle is for but he shouts at her and doesn’t listen.
8:40 pm	A Nurse brings clean, dry pyjamas for John.  He must be cold standing by the open window.  He sits on his bed and puts them on.
8:45 pm	Why don’t you lie down John?” says the nurse.  “You must be tired.” “Fuck off,” he yells at her. “Will you fucking shut up,” screams Magazine Man.
9:00 pm	John has been shouting at the top of his voice for 4 hours.  Surely he’s getting tired?  No he isn’t - not at all.
9:05 pm	“To pee or not to pee?” the man to my right shouts again.
9:15 pm	John leaves his bed and walks towards the ward entrance.  Beyond it, I can see the Nurses’ Station with all its office equipment.  The two nurses stand in his way but with fists raised, he walks through them. “I had very little sleep last night,” I am thinking.  “If I were at home, I’d be going to bed now.”
10:00 pm	John is standing in the corridor.  I can’t see him but the noise from his shouting is deafening.
11:45 pm	I ask if we can have the ward lights turned off.  They are.
Thursday
1:00 am	At last!  The nurses call Security and two uniformed guards arrive.  I know this will exacerbate things because John thinks that they are police.  “Fuck off pigs,” John yells at them.  “Go catch some crooks.”
1:30 am	I hear a tremendous crash from the corridor.  John is knocking over as much of the furniture as he can.
1:45 am	A nurse tells me that they’ve asked John’s daughter to come in, hoping that a familiar face will calm him.
2:00 am	I'm told that his daughter has said that she can’t come because she has to be up early for work.
3:00 am	There has been a standoff for 2 hours between John and the guards.  When they get close, John spits at them. The guards have managed to get John just into the ward but he is still 20 feet from his bed, shouting and swearing all the time.
3:15 am	The nurses and the guards have obviously concocted a plan:  1. While the two guards try to talk to John, the nurse slips around behind.  2. After a second or two, she taps him on the shoulder.  3. John turns round and immediately, the two guards grab his arms and pinion them.  4. Quick as a flash the nurse produces a hypodermic syringe and injects him in the arm. John yells louder than ever and is trying to wrestle with the guards but they are too strong for him.  One guard grabs and lifts his legs, while the other lifts him at the chest.  They carry him over to his bed, place him on it and then raise the bottom of the bed so John’s feet are some 3 feet above his head.
3:30 am	Every 5 seconds John, who is now trapped in his bed, is shouting, “HELP” at the top of his voice and he also yells out that he has wet himself.  I wait with bated breath and then it comes: “To pee or not to pee?”   Oh,   come on mate!  It’s not that funny!
3:35 am	A nurse approaches John who is lying awkwardly on his bed.  She tries to soothe him but fails.  She gets too close and he lashes out and kicks her hard in the head.
3:40 am	Magazine Man stomps over to John and shouts at him, “If you don’t fucking shut up, I’ll fucking do you.”
3:45 am	The nurse who had been kicked in the head comes over and asks how I am. "I'm all right," I say.   "I'm just tired but what about you?  That was a hard kick.” She smiles and sighs. "I'm fine.  It's part of the job.”
3:50 am	A different nurse comes and stands by my bed and tells me that they are trying to find spaces in other wards for us. “How are you feeling?" she asks me. "Very tired," I say. "You'll be OK in the end," she says calmly and gently. "When you die." "WHAT!"  That woke me up. "NO, I'm not.  What are you talking about?" She bends down and whispers, "We're all going to die and be with Jesus." She pauses.  "We're just passing through."
4:00 am	Magazine Man is wheeled off to another ward.  “So long, Suckers” he shouts, gleefully, as he leaves.  John shouts out, "HELP!" again very loudly and is showing no signs of tiredness.
4:10 am	To Pee Or Not To Pee is taken away too.  That leaves Peter and me in the ward with John.
5:40 am	The sun has risen and is shining through the open window.  The ward is getting brighter but John is still shouting very loudly.  “I can’t understand it, the nurse tells me.  “We gave him enough to knock out a horse.  We thought he’d sleep for 10 hours.”
5:45 am	A new patient is brought into the vacant space to my left. “How long has this been going on?” he asks me as John is shouting more than ever.  “About 12 hours,” I sigh.
7:00 am	I have my blood pressure, temperature and oxygen level taken. “That’s a lot better.” The nurse smiles at me.  “You’re almost normal.” “Thanks,” I say.  “That’s the nicest thing anyone’s ever said to me.” In future, I’d like to be known as, ‘Almost Normal Terry’.
7:00 am	Breakfast.  I just have a cup of tea.  John won’t say what he wants and Peter has Rice Krispies.
7:30 am	Peter can’t eat his cereal.  His hand shakes so much that the Rice Krispies all fall off the spoon before they reach his mouth.  A nurse feeds him.
8:05 am	John is getting quieter.  He’s still shouting but not with the regularity or intensity of before.  New Arrival leaves his bed and pulling the stand holding his drip with him, is walking towards the open window. “Where are you going?” asks the nurse. “To the window for a smoke.  You wouldn’t want smoke in the ward,” he says. “You can’t smoke here,” the nurse says.  “There’s oxygen around.  It would be dangerous.  I’ll take you outside when I’m not busy.” ”Make it quick then,” New Arrival grumbled.  “I’ve normally had 5 or 6 by now.  I’m a heavy smoker.”
9:00 am	John is quiet.  Maybe he’s asleep.  Obviously, I’m still awake. Peter is having an animated discussion with someone at the end of his bed whom only he can see. “All right, I’ll get some,” I hear him say. Peter leaves his bed and walks directly towards me.  He stops at the end of my bed and starts to pull at the curtains that surround it.  Half the curtain is already off. “What are you doing?” I shout at him. “There’s a shortage,” he tells me.  “They’ve put out a call for curtains.”
9:30 am	The nurse goes over to New Arrival and tells him she can take him out for a smoke now. “About time,” he says.  They are passing the foot of my bed. “Give us a cigarette then,” he demanded of the nurse. “I haven’t got any,” she says, looking surprised. “OK,” says New Arrival, “I’ll give you some money and you can go to the hospital shop and buy me some.” “They don’t sell cigarettes.  This is a hospital.”            “You give free food.  Why not free tobacco?” he moans at the nurse.  “I’m a heavy smoker.” “Got a fag?” he asks, looking straight at me.
11:00 am	A doctor comes to see me and apparently, I really am a lot better. “Can I go home then?” I plead. You’re receiving antibiotics intravenously and you should continue to do so for another 24 hours.  So no.” “But I can’t face another night like last night in here.” I whinge.
11:15 am	After a great deal of pleading, begging and insistent beseeching on my part, he finally agrees that I could take the antibiotics in pill form.  That, however, will mean that I’m discharging myself from hospital care against advice.  I have to sign a form absolving the hospital of any responsibility if anything goes wrong. Of course, I agree.
12:35 pm	John wakes up and starts shouting that he’s wet himself.  I don’t care anymore.  I’m going home!
2:00 pm	I sign the self-discharge form.
2:30 pm	Caroline comes to collect me. “How are you, really?” she asks me. “I’m well, I think.  Just very tired.  I’ll tell you about it later.”

I’ve read a lot in the newspapers recently about poor quality care given by nurses, especially to the old and the frail.  I suppose that those stories must be true but I can’t believe Milton Keynes Hospital is in any way exceptional or different from most. 

Not only would I not want a nurse’s job, but I also couldn’t do a nurse’s job. No words can convey the admiration that I have for those I met.  They were wonderful, patient, caring and kind.  Nurses tolerate the intolerable.  They work in impossible conditions and I think they are almost saint-like.

What can be done with patients like John?  He is clearly suffering from dementia, as he had absolutely no idea where he was, what was happening or what he was doing.  He was constantly bewildered and very frightened.  I can’t even start to think of a solution. 

Another thing:  Every nurse that I met in those 24 hours spoke with a foreign accent, and came from Eastern Europe, The Far East or the Caribbean,

I wonder what UKIP would have to say about that.

22/5

David, whom I was at school with and I have mentioned several times in the past, left the following as a 'Comment'.

I don't think many people read the comments and so I have put it here.  It amuses me hugely.

I was in hospital in the orthopaedic ward, in May 1971 having knee surgery.  On Saturday afternoon, just before kickoff, the patients were taken (wheeled/carried/lifted) into the TV room to watch the Cup Final between Arsenal and Liverpool.  Because of the hospital’s location, virtually all the patients were Arsenal supporters.

It was 0-0 after 90 minutes.  Liverpool scored in extra time.  The room went very quiet.  10 minutes later, Arsenal scored.

My companions, in the euphoria of the moment, forgot why they were there.  They leapt to their feet, arms raised and then came crashing down.  It was like watching a room full of dominoes collapsing.  5 of them had to be helped up from the floor by nurses and 3 of them had to have their plaster casts reset.