Wednesday, January 23, 2013

the cowardly leopard

It snowed so heavily last night even the washing line has a covering; it sags across the garden in a delicately-bladed curve of ice. Every detail has been re-modelled by the blizzard, every feature fattened and made strange, from the stone bird bath in the middle of it all to the tangle of vegetation through the empty frames of the tumble-down greenhouse. Track lines of animals and birds criss-cross in the snow, this one clearly a cat; that one strangely melted and then re-frozen, so you’d think some kind of bear had been out foraging.

Mrs Leppard has slid out of her chair. The carer found her and called us to get her up. And even though she says she’s frightened of going back to hospital, really we have no choice, because none of the arrangements that should have been in place before her discharge – the commode, the rails, the bed with sides, the hoist – nothing has been done. Maybe the snow has slowed these things up. Even the heating is ineffective.
The carer hands me a folder.
‘They discharged her yesterday after an admission for decreased mobility. She was offered a stay at an intermediate care facility but Mrs Leppard turned it down because she was scared it meant she was being put in a home.’
‘I’m not going in no home!’ says Mrs Leppard. She grips the sides of her chair as if she’s getting ready to jump up and sprint away. But her sprinting days are long gone. The only real animation about her now is in an exaggerated facial expression of anxiety, her chin bobbing up and down as if her jaw muscles had been replaced with elastic bands.
‘I’m a coward,’ she moans. ‘I’ve always been a coward.’
‘You’re not a coward, Mrs Leppard. Anyone would be worried – it’s quite natural.’
‘They said they didn’t want to see me again.’
‘Who did?’
‘Them at the hospital.’
The carer kneels down and drapes a young hand over Mrs Leppard’s liver-spotted claw.
‘I think you’ve taken it the wrong way, Sheila. I think they meant they didn’t want to see you back in hospital because that would mean you were sick, and they want you to be well.’
‘They’ll be so cross if I go back.’
‘No they won’t. Honestly they won’t.’
We set up our carry-chair, lift her across and swaddle her in blankets. ‘It’s cold, Mrs Leppard,’ which is true, of course, but we’re also mindful of the treacherous route out to the ambulance. We don’t want Mrs Leppard tipping us over with a panicked grab.


We settle her onto the ambulance trolley and stow the chair.
‘They’ll be angry,’ she says.
‘No they won’t, Mrs Leppard. Everyone just wants you to be safe and well.’
‘I’m such a coward. Not like my husband. He was too good for this world. He died twenty years ago. Twenty years! He was sick though. He had problems. With his heart.’
‘Oh yes? What kind of problems?’
‘You know. Whasisname.’
Her jaw bobs up and down as she casts her rheumy eyes about the ambulance interior.
‘Ischemic heart disease,’ she says, suddenly. ‘Ischemic heart disease, and erm... something else...’
I wait a moment.
China?’ she says, appalled. ‘He never went to China.’
Rae slams the door shut. A shouted goodbye to the carer, then the slushy trudge of her boots as she goes round to the cab. She calls the leaving time through. I write it down. We start to move.
‘They’ll be angry with me. They said they didn’t want to see me back there again.’
‘Try not to worry yourself, Mrs Leppard. Everything’s absolutely fine. The doctors will check you over, and then if everything’s okay – as I’m sure it is – maybe you’ll still be able to stay in that intermediate care place for a little while – not long, but just so you can properly get back on your feet. And then whilst you’re in there, the team can make your house ready with all the equipment you need.’
Her mouth springs open again and she struggles to sit herself up on the trolley.
‘I don’t want no-one in my house!’ she shrieks. ‘They’re not to go in without my say-so. I’ve told my solicitor. He knows all about it. He’ll stop them. I won’t have it. I won’t have it. There’s all my things there. My private things. I won’t have them going in there.’
‘Try not to worry about it, Mrs Leppard.’
‘No-one’s allowed in without my say-so.’
‘Okay, Mrs Leppard. Okay. I’m sure you can talk to the doctors at the hospital about it. They’ll be able to put things right. No-one’s going to do anything you don’t want to do. Okay? Everyone’s just trying to help.’
She eases back into the trolley, and begins plucking at the blankets.
‘That’s all my things,’ she mutters. ‘My things. I don’t want no-one touching them.’
Her jaw bobs up and down, gradually slowing. She doesn’t say anything else.
The ambulance heater powers up.
Mrs Leppard closes her eyes and passes the rest of the journey in a fitful kind of sleep.
I read through my notes.
The radio plays quietly through the hatch.
We hiss and splash along smoothly, making good time. Even though the side-roads are almost impassable this morning, the main routes are pretty much clear. 


jacksofbuxton said...

I'm quite concerned by the idea that because the care team haven't done their bit,the best place to take Mrs Leppard is hospital.

Although if she doesn't want to go to a care facility,what can you do Spence?

Steve'nLubbock said...

So sad when end-of-life issues leave us like this. The choices are few, and none are attractive to someone who's spent half a lifetime in one spot.

Spence Kennedy said...

Jacks - I know - these failed discharges always feel like a big disappointment / failure (which they are, of course). It's symptomatic of the pressure on beds at the hospital - they turf them out before they're really ready. Mind you, Mrs L. had refused some Intermediate Care, so she wasn't what you might call compliant. From our point of view, the bottom line is if she's not safe to be left at home, she goes in. There is a rapid response / hospital avoidance team during office hours, but she didn't really fit the criteria. Shame. I've no idea how they're going to sort her out, though. She isn't facing up to the realities of her situation (like that's headline news...!)

Steve - It is sad. I think all we can do as a society is provide good care at home right up until that becomes untenable, then equally good residential care. I suppose the ultimate sadness is that people fall ill and die - but then, death is as much a part of life as birth, so really we should prepare for it with the same compassion and forethought. I do think that care of the elderly - and death rituals - are as potent a marker of a civilisation as anything else.