Tag: disability

A couple of numbers

Four thousand five hundred and seventy-two. That’s the number of days I’ve been providing care for MW in some form or other. Right from the first symptoms of her MS: a bit of a limp and eyesight problems. Back then, it was just guiding her around as much as I could. There have been many stages of gradual progression of symptoms.

The first year following diagnosis: coping with blackouts and begging her to eat because she stopped eating, thinking she’d get fat from being immobile. Dealing with her continence issues, including stopping a London – Edinburgh train at Doncaster so I could take MW to the disabled toilet and change her clothes, as there was no disabled toilet on the train and she’d had hot coffee spilt on her. Her gradual loss of mobility: lifting her in and out of cars, on and off beds, chairs, etc. Feeding her for the first time: an unsaid but mutually acknowledged sense of a loss of dignity.

There have been good times post-MS. My 40th birthday year. The year we went on holiday to Europe. We met friends and had fun gadding about the continent’s fashion capitals. Getting giddy because we were ushered past the velvet rope in the Louvre to get that bit closer to the Mona Lisa (one of the few advantages of being a wheelchair user). Having a private tour guide to show us around the Vatican and Sistine Chapel. Shopping together in Milan and the hotel’s delicious chicken sandwiches. My eyes get a little more misty each time I look at the photos. Of how things were.

One. The first. Today was the first day I told someone official that I can’t cope any more: I can’t keep going to the well of strength because it’s almost dry. MW is in hospital after her swallow became compromised. I couldn’t tell if fluids were going down properly or not. There was no evident deliberate swallow. She’s due to have a PEG tube fitted and that operation has been brought forward. The risks involved are scary: more so given MW’s progression.

This hospital admission has been the most upsetting because she seems so weak now. I think I’ve cried every day bar one. Tonight was rough. Her breathing rate was a real cause for concern as it had got so low. Every conversation seems to have that sombre tone – do you want us to resuscitate in the event of…?; do you want us to ring you during the night if her breathing rate falls below…? I can’t even bring myself to type the words.

Those of you who know me already know that I lost my Dad to cancer two months before MW and I were married and five months before her symptoms began. What you may not know is what happened when he died. I was all set to go across from where we lived to my parents because the Macmillan nurse had said things were getting towards the end and I’d said I wanted to be there. I’d also started with panic and anxiety symptoms and had a doctor’s appointment that same day. I’d travel across the next morning.

You’re probably way ahead of me already. I did travel across the following morning, thanks to a lift from a friend of my Dad’s (now no longer with us. Brian was one of the kindest, most selfless men I’ve ever had the privilege of knowing). A journey of 110 miles, give or take a mile or six. Twelve miles from their home, my mobile rang. He’d gone. I’d not seen him at the end. I got to their house to see his body lying in a hospital bed in their front room. Shock, sweet tea, grief.

Looking back, I preferred it happen that way. I couldn’t watch him take his final breath and go. I know I will have to be there when MW takes hers, whenever that will be. I know she needs the comfort. I know she needs the reassurance and love that we – her family and I – will provide. I’m just not ready for this to happen now. This deterioration just seems so sudden. There seems to have been no time at all between listening to her giggle with her Mum and a carer and seeing her in hospital, reduced to being made up of hourly observations, fluid balance chart, IV fluid intake rate…

This pretty much all boils down to me saying that it’s not fair. She doesn’t deserve this. Why her? Why does this thing keep making her worse? Why is it going to take her from me? Screaming won’t change anything, I know that. I’m scared. I’m struggling. People keep telling me that if I wasn’t this way, I’d not be human. It means I care. That being with her despite this also means I have strength. Somewhere, I know this – I just wish that strength didn’t hurt so much.

Decisions, decisions…

It’s been a while. A lot’s been said since I was here last. And there’s a lot to think about. Because MW has significant cognitive issues now, it’s left to me to be the “memory” and, to all intents and purposes, the “decision maker” for all issues. I have to be the “memory” because MW can’t remember what’s said on a day to day basis, never mind when discussing important issues.  I have to take notes and remember what’s been discussed. She was even asleep during one of the consultations. I’m also the “decision maker” because, despite the fact MW has the absolute final say in whatever happens, she relies very heavily on my opinion. She has real difficulty in making decisions, even for something as trivial as deciding what to eat. So I have to “make” a lot of decisions on her behalf, i.e. explain why I think a certain decision is the best one and get her to say yes or no.

We’ve had two important consultations this last month. The first one wasn’t supposed to be that important, it just turned out that way.  This was a conversation with an OT at the splint clinic – for MW’s hand/arm contractures. Finally, someone has given me their opinion re: MW’s care. I get that professionals aren’t supposed to do that because all decisions are supposed to come from the patient. But it wouldn’t be so bad if they’d offer advice. No-one seems to want to do that. So, I’m left with the impression that the level of care MW receives is considered appropriate for her very advanced needs. Even though I’m fairly certain that most professionals we’ve seen wouldn’t draw the same conclusion – if they were of a mind to forward their opinion, that is.

According to the OT’s professional opinion and looking at the situation with a cold eye, residential care would be the preferred option now, for quality of care, etc. Hearing that was a bit of a relief. Not that I have immediate plans to move MW into a home. But I now have some kind of gauge to go off so that keeping her here isn’t detrimental to her health. I have a yardstick to use. Although not expressed directly, MW’s demeanour when we talk about her staying at the short-term respite home tells me that she wouldn’t be keen on residential care. What MW and I must do now is discuss the long-term future and find the balance between ensuring quality of care and quality of life. I’m not medically trained. Everything I know is through experience – some more bitter than others – or through picking up bits and pieces from medical staff. And I’m doing this on my own. I can’t do it forever and still maintain her quality of care.

The other conversation was always going to be more serious. MW’s contractures are pretty serious (I’m having a hard time not singing the word “Contra-ac-tures” in a Debbie Harry voice). This is a shortening of the muscle or joint affecting her hands, arms and neck. Her hands are pretty much shut tight now. So much so that the knuckle joint at the end of some of her fingers bend back on themselves due to the pressure of the contracture. I keep thinking it’s going to break at some point. Her arms are permanently crossed and her neck’s at a permanent 70º angle to the right, which makes feeding harder and has knock on effects with swallowing and breathing.

The consultant talked about surgery – under anaesthetic, they’d attempt to stretch and set hand and arm ligaments. Possibly some neck manipulation. Alternative surgery includes the amputation of the fingers at the first knuckle. Again, for hours under general anaesthetic. None of which is guaranteed to work or not to cause pain. Also, any general anaesthetic will be a challenge. Because of the existing contracture in MW’s neck, she may require awake intubation. This requires a tube being inserted into the nose and down into the throat, then a wider airway tube being threaded over that first tube. All whilst awake.

The anaesthetic is a whole other thing. MW is getting weaker and I don’t know if she’d be able to withstand what will undoubtedly be hours of surgery under general anaesthetic. I know that all anaesthetic comes with risk. That’s compounded by these pre-existing problems.

This is all quite a responsibility to bear for someone else. It’s hard being the “memory” and de facto “decision maker”. I’m going to have to walk a tightrope between wanting to respect her wishes, even though she’s not expressed anything directly on either subject, and doing what’s best for her health. I won’t lie, I’ve been going round in circles on both issues and I don’t have any idea what to do. But, now that I’ve had proper, professional opinion on the state of things as they are, I’m all too aware that time is running out to make a decision. I only hope I can help her make the right one at the right time.

Coping

For the first time, the thought “I can’t do this any more” fleetingly entered my head.

The “I can’t do this any more” thought came into my head last week.  MW had two choking fits in one day.  The latter of the two being more acute.  I’m holding her upright while she’s struggling to breathe, unable to move, and trying to cough up the foreign object – a stray bit of regurgitated food or drink.  I pressed the button to alert the carers and one of them came to help.  Neither of us could do anything practical.  We can’t go into MW’s airway/lungs and pull out whatever it is that’s caused it.  The warning sign is always a gurgling sound in her stomach followed by a quiet ‘burp’ sound and frantic coughing.  Sometimes it’s not very bad.  A few coughs and it’s out.  Other times, it’s more serious.  Breathing becomes a problem and I can do nothing to help.  On more than one occasion, I’ve had the phone in my hand, ready to call an ambulance.

I had another panic attack last night.  Not as bad as a couple of weeks ago.  Probably a build up of stress coming at me from all sides.  I suspect that this post will elicit some advice along the lines of “you need to reduce your stress”, “is there anything you can do?”.  I know I need to do something about my stress.  Or it really is going to have a lasting, drastic effect on my life.  After the choking incident, I had a quiet moment to try to forget the sound of MW gasping to catch her breath and the feeling of utter helplessness.  That’s when it popped into my head.  “I can’t do this anymore”  “My best isn’t good enough”

So, I’m coping.  At least, I think I’m coping because I’ve not dropped any of the plates I’ve got spinning, but maybe my body is trying to tell me otherwise.

This is the hundredth post I’ve put up on this blog.  In the run up to Carers Week, and the 5th anniversary of starting to document life as a carer, I’ve been posting pictures of items necessary for daily life here.  Here, this is me lifting MW into a car so we can go shopping.  I’ve done this hundreds of times but never seen myself do it.  So I asked the carer accompanying us to take this video.

Yes, I know you can get Wheelchair Accessible Vehicles.  But MW hates being “shoved into the back like cargo”.  This is an argument that will have to be resolved soon.

Taboos

Following on from the last post, and those fears I touched upon, I had a conversation with my GP.  He’s not just *my* GP.

Out of the blue, he asked me a question that made me freeze a bit.  He wasn’t being cruel.  Just realistic.  He said he recognised the bluntness of what he was saying.  The conversation was vague but it’s out there now.

Loss.

I’m finding it hard to write this without making someone else’s grief about things here.  I know it’s not right but I hope they’ll forgive me, and that anyone reading this will understand why I feel this way.

Last week, we said goodbye to a friend – S.  S was only 32, and had fought MS for half her life.  I know her family more than I knew her.  They cared for her throughout her battle with progressive MS and were with her at the end.  To say that her passing was a shock is an understatement.  Like many diseases of this nature, MS didn’t provide the final blow.  That was left to pneumonia – a dangerous threat on its own, without having a compromised immune system.

I saw S twice in the three weeks before her passing.  First, when I took MW to look round a respite home, she was a resident for that particular week while her parents took a break.  She was asleep in front of the TV in the home’s common room.  She looked peaceful, relaxed, and rested.  And well cared for.  The home’s very good and seeing S so relaxed helped put MW’s mind at ease about staying there.  That’s important for any respite break – but I digress.

The second time was the day before she left.  In a hospital side room, in a scene that could have come from any TV show or film.  Machinery, tubes, cables – I’m sure you’ve seen something similar, either on a screen or in real life.  Her mother had told me a few days before that she was in hospital and was extremely poorly.  We visited her while MW was in hospital for an appointment.  Spent a little of what we now know was precious time with her.  S had been given some glass butterflies.  Her mother gave one to MW while S had another in her hand.  They were linked.  Like two wings of the same butterfly, I guess.

The MS that S battled was similar to that which MW has.  She was the only person I know or know of in a similar position.  I know what her family had to do on a daily basis.  Which is why I wished with every fibre that S would recover.  That life wouldn’t be so cruel to someone so young who didn’t deserve to leave so early, or to a family who shouldn’t have to face the prospect of losing a daughter or a sister in her prime.  I also know that S didn’t deserve to suffer as she did, nor did her family who saw the effects every day.  She’s no longer suffering or in pain.

I’m no altruist in this regard.  It didn’t take long for her family to realise what was going to happen.  But I wished and willed S to recover, partly for selfish reasons.  Not to prolong any suffering but for reasons of hope.  Because her passing plays on my fears of inevitability.  Of a taboo subject and thoughts that we can’t – daren’t – articulate.

Meanwhile, we fondly remember a beautiful butterfly who has now spread her wings.  And, if the music at her funeral is anything to go by, is head-banging to her heart’s content.

Feeding: a habit

No screed of a post this time, just me emptying my head into the void.

MW and I would usually join our old branch of the MS Society for their Christmas dinner.  Not this year.  As MW now needs to be fed more often, we’ve decided not to go.  We both know that there will be other MS sufferers there who have to be fed but we’ll still not go.  It’s one thing to have to have to be spoon-fed at home, it’s another to do it in front of 100-120 other people.  It’s about dignity, I guess.

MW also has another pressure sore.  What you may not know is that not only is a pressure sore very difficult to heal (a previous one took 5-6 months to fully heal) but skin breaks exacerbate other MS symptoms.  We suspect it came from a blister caused by the hoist sling.

It’s odd how such small, innocuous things cause major problems.