My Step-Mum-In-Law has been in a nursing home for a few weeks. I have tried to keep contact with her, not least because one of the reasons demented people go downhill rapidly upon entering residential care, is their disconnect with all things familiar.
Unless you are a seasoned world traveller, you will have some understanding if you have ever been on holiday to a country with a culture very different to your own. There may be guards with guns at the airport and the toilets could be strange. The currency looks odd and needs to be scrutinised and you don’t understand a word anyone is saying to you.
This, magnified, viewed through the fog of dementia, is the world of anyone newly resident in a care home. At the time everything in the surroundings most needs to be familiar to give reassurance, it isn’t.
For these reasons I tried hard to keep contact with SMIL, to be the familiar in the unfamiliar.
The prefrontal cortex of the brain, the bit behind your forehead, is the place where all the complex interactions with other humans take place. In dementia, as in alcohol or drug use or withdrawal, these most delicate and nuanced workings are unavailable. Thinking happens by electrical jumping between the synapses, the ends of the nerve fibres, to grossly over simplify matters. Our brains are not hard wired, any nerve ending can connect with any other nearby nerve ending, which has to be one of the best designs in the universe. But it is fragile. Fraying the nerve end with a drug or blocking the space with a plaque is like cutting the toaster lead with scissors. No toast. All the new thinking is doughy.
However, in the demented brain, well worn thinking becomes hard wired. If you are out rambling through rough grass, you can see the trampled pathways and follow them because the walking is easier. So the demented person is happy with familiar thinking, they know where it is going. As my mother’s dementia worsened, one of the few things that would sooth her was getting out the old photograph albums.
So, doing what I could do, I tried to keep chatting to SMIL. However, this involved ringing the main office, requesting whoever answered the phone to find A) the nurse’s mobile phone and B) the SMIL, then ring the Nurse’s phone number and be connected. If she would talk. At first she would talk, unless she was making friends with the other residents, in which case the phone would be put on a table and forgotten. She does have a mobile of her own but cannot use it, or understand what the ringing noise might be, although she has twice used it to call the police, her daughter informed me, very upset. As my mother used the phone in her flat at her care home to call the fire brigade three times, who did turn out, in case she was the last resident in a burning care home, I was less upset.
All the official pamphlets and literature about dementia tell you that, as the demented person is incapable of functioning in your world, you have to enter their world, to get inside their head and appreciate their world from their point if view. This can be very like entering not just the dragon’s den, but the dragon. An utterly irrational world is a frightening place.
Since the start of the pandemic I have been sending photographs of her step great grandchildren, taken by the DIL to the SMIL’s tablet. The SMIL loves the photos and the little videos of the GGCs playing in the park, whooshing down slides and spreading ice creams down their nice clean clothes.
She has recently lost the know how to work the tablet. The GGCs had visited Legoland for a birthday treat. I printed off the photos and sent a concertina booklet to the SMIL. When I rang, she told me she had just got out of the shower and that it was the first shower she had had for ten years. Rejoicing in her cleanliness, I enquired if she had got the photos, she replied that she had and then began swearing at me and hitting the phone on the table.
This sort of scorching is always a surprise. Slightly charred, instead of running round fanning the flames, I endeavoured to do thinking.
I knew the SMIL was on antibiotics for a water infection and, the first course having proved ineffective was on a second course. Which, given her response, didn’t look as if it was working either. Now, why was that?
One of the characteristics of dementia and old age which has not been adequately explained to my liking, but which, if I live long enough, I’ll tell you all about, is the problems caused by human plumbing. It’s not just the waterworks, which, I can already tell you (hurrah! knowledge. oh. hurrah.) suffer from lack of collagen as we age. Collagen is the body’s elastic which makes things that ought to be plump, plump. Your body decides not to bother making as much, starting at about age thirty. At my age even your wrinkles have wrinkles and if you are still working on losing weight, your wrinkles’ wrinkles have wrinkles. And so has your bladder. Your previously elastic water carrier is thinner, weaker and needs emptying more often because it is thinner and weaker. If it was a bag for life supermarket carrier you’d have swapped it for a new one ages ago. This problem affects both species and all the intermediaries. Then there’s male hydraulic problems and all the inherited female difficulties caused by balancing heavy babies on just the one pelvic floor. Human plumbing is long overdue for a redesign. My old family doctor was fond of explaining that those bits and your nose would work perfectly all your life if we still walked on all fours. He used to chuckle about it mightily until he got older himself. I strongly recall an episode of a Star Trek spin off in which a pregnant crew member, struggling to give birth, just had the baby beamed out of her and on to the table beside her. That would be handy and save a lot of subsequent bother.
The SMIL had two children, a little late in life, as she had been told she couldn’t have children. Much later on, the pelvic floor problems occasioned by late pregnancy became evident as she aged. She had a prolapse, which she told me about on the phone. A prolapse consists of organs which ought to be inside of you, falling out through the holes. I assured her it was a medical problem and really did need help from the doctor. She was reluctant but having frightened herself by physical evidences of the prolapse on several occasions, was eventually encouraged to get help. The doctor assisted with an internal anti-gravity device, which needed regular replacement. SMIL was not happy about the outcome and used to complain to me each time the date rolled around, but the fix worked and she was OK.
Now, remembering this, I considered that if the SMIL’s son had taken her to the doctor, the last time he could have done so would have been over six months ago, as he had committed suicide in the spring.
I also recalled how very off the planet and aggressive my mother used to be with a simple water infection. If you get such a thing, you will know it. You’ll be able to pinpoint the source of the misery every time you crawl to the bathroom. This information seems to be unavailable to demented people. One of the first items to be brought into my mother’s house by the carers was incontinence pads. I was assured she would need them but she never did. How much this had to do with the fact that she had never had a great weight sitting on her pelvic floor, as I am adopted, is difficult to calculate, but I think it had a significant effect. She continued to know when to visit the bathroom for the whole of her life, which, although you might be young enough not to have to consider such a thing, is a great blessing. This did not stop her having frequent water infections and being aggressive every time. After a couple of years we eventually got wise to this, and if she was really ratty, suspected an infection and got started on the antibiotics before the ambulance rolled up at the door. Eventually she was on antibiotics permanently, which of course, left no resources when matters worsened. This common fix helps to explain why viruses can romp through care homes.
Back in the present, putting all of the pieces of the puzzle together, I rang the SMIL’s nursing home and, speaking to the chief nurse, acquainted her with the situation as I saw it. The nurses are not able to access the residents’ medical notes, but the doctor, who visits every Monday, can. He will read back through the SMIL’s notes and find out if an elderly festering anti-gravity device is the source of the infection.
If you have not yet reached the stage of involuntary dribbling, weeing and hitting passers-by with your walking stick be glad of every moment. If your body works, look after it. Be really nice to your relatives in the hope that, if you need looking after and can no longer do your own thinking, they will do so for you.
If like Captain Picard, you are engaged with someone temporarily or permanently off-world, just try to keep the lines of communication open. One day it could be you breathing fire at the villagers and hoping someone knows how to work the extinguisher.*
*This entire post sponsored by MixedMetaphors4U and Spot the Brane board books.