Monday 15 August 2011

The Long Slow Fall

‘Coo, that’s gone quick’.




Almost everyone I know has said a version of those words, commenting about the ending of my eight week student nursing placement in a dementia care home. Most of the time I’ve nodded and changed the subject while inside I’ve been screaming, ‘No it hasn’t, it’s been one of the longest and toughest periods of my life’. I had understood that having completed this elderly care placement, I wouldn’t be required to do another one, but last night, my friend informed me that it’s one a year. I almost choked on my bombay mix.



I still don’t understand why dementia care is not for me. I liked the people I was nursing. My mentor said that most students start off frightened by the strange noises, odd behaviour and personal care. I explained I was positive I could work with all staff groups (ouch that’s more a groan than a laugh). I was confident though. Because dementia is a type of mental impairment, the overlap with working with people with learning disabilities is extensive so all of my old skills kicked in. Naturally, my distaste for the model of care that involves getting 42 strangers all with their own problems to live together in someone else’s house kicked in as well. Especially as the someone else happened to own an extensive collection of vintage cars. I believe in Person Centred Planning, I cried, Get Me Out Of Here.



The staff were mostly kind to me, and they do their best in under-resourced circumstances. The shift pattern was convivial (early starts not too early). I had some time off to hit the library. There were tea breaks. I got used to having to wear the uniform. My mentor was intelligent and experienced, happy to engage in discussion. It should have been a breeze, and yet I never got comfortable.



Student nurses are implored to value even the difficult placements as learning opportunities. I went all in on this, and I’m much better informed than when I started. Practical skills (dressings for pressure ulcers, suctioning, injections...) buzz along in my head with assessment and care planning frameworks (Continuing Healthcare Funding, Oxford Care Pathway, Gold Standard Framework) circled by issues of nursing ethos (own training, management of staff, where responsibility rests and the gaps left between). Then there are the different forms of dementia, including Korsokoffs – alcohol related – the kids are tired of me telling them not to drink. I’m far more familiar with the musical The King and I than I ever expected to be. I wonder if Tom Kitwood, father of person centredness realised that his work would be so taken up by learning disability workers while being underutilised in Dementia where he developed it.



There have been beautiful and moving times. A woman asking me ‘Look, you say this is my home? Well why are all these people here? I can’t afford to cook for them and clean for them.’ A lady waking suddenly from sleep, frightening us both ‘I don’t know you’, and me apologising and agreeing with her although she had seen me around ‘But you’re nice’ she said, rolling over, curling back into slumber. A man obsessing over the work he had to do, lifting and breaking things beyond his strength, yet holding my hand gently, telling me about his father. A woman screaming and fighting, calming with a few words reminding her of who she was. A bath, another bath. Weetabix. A discussion about Scottish nationalism another about education and another about curry. Elvis, Abide With Me, and the discs they used to give away with Sunday supplements. My own soundtrack to it all, Chris T-T’s Tall Woman, and the metaphor of the ‘long, slow fall’.



Boiling it all down to the last week, when I’d got used to the place and started to think I enjoyed being there was this: my work in caring for people so far has been all about life. Living the best life in spite of the bad hand that has been dealt. Helping people live well. This placement has been about the opposite – about how to die well, and about waiting for death...in slippers...eating mashed potato...enjoying Tom Jones until finally, after a year or ten comes morphine and a CD of ‘Angel Music’.



I admire the people who work every day helping people to do this, but I’m forced to own, it isn’t for me. It’s taken 43 years to come to the infuriating conclusion that I can’t do everything. No wonder I’ve spent 8 weeks sad, frustrated and annoyed. Like it is when all relationships fail: Dearest Dementia, it’s not you, it’s me (and a bit you to be honest).

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