Leaving a home for a home

When Simon Parkin's grandfather moved into a nursing home, his grandmother was left alone in her cold house. Who has it worse, he wonders?

 

Every summer holiday I’d lay awake on the narrow bed and listen to the only other piece of furniture in the room – the hulking wardrobe, as the beetles dined. This was the nightly ritual at my grandparents’ cottage, where the insects would feast en masse during the dark, tapping their mandibles loud against the wood till they finally stilled, replete at dawn. It was the closest I came not to adolescent rage but to adolescent madness: whipping from my bed, torching the light and poring, murderously over the bedroom furniture for something, anything to obliterate under thumb.

Nowadays the diners are gone, dispossessed by decay perhaps, as the wardrobe’s grain grumbled past its sell-by years ago. The house is all decline, its ceilings fissure-scrawl maps, its walls threaded by varicose veins of damp. It’s been this way since I can remember – close to three decades - but it never really seemed to matter very much before. The house was held together by warmth and love.

The beetles aren’t the only evictees. My grandfather departed shortly before Christmas, siren-wailed into a local hospital’s waiting bed where the staff mended what they could before making the grim pronouncement: he could not return home. His care was too much for my wearied grandmother to provide; he would need to find a new place to live.

The benefit of terminal illness – and it’s a grim benefit, but a benefit nonetheless – is the schedule it brings. Sure, the sentence is elastic: they might give you two months and you cling on for twelve, or two weeks and you’re wilted and gone in a day; but terminal illness and its prognosis sets the pace of one’s decay.

Mere old age - the sort of old age my grandparents are suffering - has none of that. It’s all unwelcome surprise, slo-mo shock horror. Death grows in us like a baby, its presence felt more each year, its strengthening kicks acting as reminders of our inexorable decline. But death’s final birth remains, for many, unannounced. It arrives to crown old age when we’re least expecting.

This is the problem for the elderly couple separated by unsynchronised degeneration. One remains in The Home, healthy but lonely, clinging to the household debris of memories. The other is sent to A Home, cared for but lonely, sitting in some medicinal chair facing a window on to a road that winds back to the old house and its memories.

Who is worse off in the arrangement? The left-behind, with her uneasy freedom and schedules that swivel around the visiting hour appointment, or the intrepid handicapped, deafened with drugs and the aggressive scent of industrial-scale linen-washing? He too awaits the visiting hour, but with a sapless tongue, his time now measured by the rising yellowy-tide in the catheter bag and the unwavering TV schedule.

“I’m not going yet,” my grandmother says, defiantly, all weekend as I stay with her. “There’s too much to do around this place anyway. And I’m certainly staying put till I’ve drunk all of the homemade wine.” We both laugh, long and eagerly – more than the joke deserves, but less than we need to.

Over our weekend together this becomes our battle cry of united defiance whenever a reason for moving out reveals itself. “Not yet!” she says. “Not yet!” I echo.

But she is preparing. She’s been preparing for years now, asking my brother and me to point out the household objects we’d like to inherit when the day comes. She would stick Post-It notes to these items’ bases with the relevant sibling’s initial drawn on in marker pen. I always saw this as a morbid request, and felt greedy and uncomfortable in answering her. But she was just preparing, trying to take care of things; being a good grandmother.

“I’m worried that he’s not eating enough,” she says, later. “Maybe I should move in to ensure he’s getting enough food?”

I point out that she is paying an extortionate amount for her husband to stay in The Home’s care and that it's the staff’s responsibility to ensure he is putting enough away. “Yes,” she says. “Yes you’re right. I’ll get your father to have a word with the staff.”

“That’s the spirit!” I say.

“Not yet!” She smiles, ruefully.

The government has been trying to improve the lot of our ageing population of late, or at least trying to appear to try to improve their lot. For many, the final years of life consume everything that was built up beforehand, at least in financial and material terms.  Last month the coalition committed to fund any care that an individual might require over £75,000 (a full £40,000 more than economist Andrew Dilnot recommended in his review). That, of course, doesn’t go towards the cost of care in a new home, only treatment. Regardless, a financial solution can only ever be a partial solution. There are deeper, wider factors for any couple facing a care home, ones that grow yet wider if the couple in question cannot move together – factors to do with guilt, loyalty and the incomprehensible pain of a separation that was not asked for.

I have my own cause for worry too. The house (fissured, varicosed) is also close to freezing. My grandparents were born pre-war and, like many farmers of their generation, live as if rationing was still in angry effect. Heat is doled out from the electric fire in momentary burps, before the ‘off’ switch is thriftily flicked and yet another woollen cardigan slipped into.

“You eat too quickly,” she admonishes, often.

To be this cold inside a home is unsettling for the contemporary human, who reasonably expects walls and rugs to offer adequate shelter from the cruel elements. I take two hot water bottles to bed and watch as steam rises, not just from my breath, but also the ambient heat of my fingers. She’s not ready to move out yet, psychologically but also physically. And yet, this is no place for an elderly lady to decline, drawn smaller by the temperature, diminished by the absence of warmth and love.

Sleep is death’s brother. But in this sort of cold, they’re twins. There’s no longer even the insect’s tap to act as a heartbeat indication of life any more, the questing micro-jaws whose nibbles and scrapes can keep a man warm through mere irritation. All that’s left is the air of cold immobility that precedes decay. And the questions - those unanswerable questions.

My grandmother wakes me first thing with a rap at the door. She’s still wearing the headscarf she slept in, tightly wrapped and tied beneath her chin. She’s eager for me to hit the road, grateful for my company and the various errands I helped her with, but ready for me to be on my way now. The new day has brought with it fresh challenges and to-dos which I am not to be a part of and, moreover, she’s worried she’s keeping me from my own familial responsibilities. This is the curse of the kindly matriarch left behind: managing everybody else. “Come on,” she says. “Time for you to get home.”

We lock eyes and I smile.

“Not yet!” I say. “Not yet.”

 

A cottage. Flickr/markhillary, used under a Creative Commons licence.
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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear