Determined as I am to finish the decade with a positive spin, here comes the festive blog! It will be joyful and packed full of angels, egg-nog and flashing reindeer antlers that look better suited to a hen-party (it won’t).

Christmas Eve

T’was the day before Christmas and one of my patients, usually a man of few words (most of them surly) brought me a box of chocolates and a card to say thank you for various bits and bobs I’ve done over the past year. Chocs have been placed on a high shelf at home away from scavenging hordes of children already razzed up on X-box, mince pies and fizzy drinks. The card is in pride of place on my surgery windowsill – it’s hard to overestimate the loveliness of receiving gifts / cards / kind words from patients.

For balance I also read an online article from one of the more hideous tabloids about how lazy GPs are refusing to work despite enormous pay incentives – I suspect we’re being lined up as the fall-guys for some nasty legislation in the new year – here’s hoping!

Lots of prescriptions for antidepressants were offset by festive cheer from patients and reception staff – everyone wishing each other Happy Christmas despite ailments and no traffic on the road for the journey to work before the sun rose = result!

Message from friend, whose husband was sent out to buy Christmas gifts and who came back with no presents for his daughters but a lego set for himself, provided festive merriment (photo of him with his lego, which she has captioned “Twat” ).

Home in time to watch Elf with the kids and get to Christingle service. Completely battered by 10pm but had to wait up to allow the man in red to perform his duties (not a euphemism).

Christmas Day 

We headed over to Mum and Dad’s after church to find brother-in-law already elbow deep in turkey and beef – both of which had their own app on his phone to alert him to temperature changes whilst cooking. Mum was sat in her chair and looked on in benign bemusement as the kids tore about the house with their cousins. She’d been visited by the Christmas fairy (Beatta, one of the favourites from the care agency) who had dressed her in a festive red jumper and put a bit of make-up on. Dad had been musing over whether to get anyone from the agency in on Christmas Day but when he told me that Beatta was working and that for her, Christmas Eve was more of a priority in terms of holiday, it seemed sensible to nudge the, ‘Oh, don’t worry, I’ll be able to manage fine on my own‘ into a, ‘Well, if Beatta’s going to be working anyway perhaps I’ll book her.’

The initial resistance was two-fold; firstly there is a natural inclination to not want to make someone work over Christmas. Stories of staff being called into warehouses at 4 am on Boxing day and Amazon delivery drivers knocking on your door just after Christmas dinner with a parcel that really could have waited, make some people uneasy. It feels like an abuse of power to insist that on a national day of rest, some poor sod has to schlep over to Mum and Dad’s to get a not-so-old lady out of bed. In addition there is Dad’s default ‘I can probably manage’ attitude, which, as we’ve already established in previous blog posts, has caused some issues. A gradual chipping away is the best approach and on a drive down to Somerset last week I managed to push the idea of an hour of care on Christmas Day as well as a more regular fixture of having someone in to help in the evenings going forward (he was a captive audience whilst driving back from a funeral so I thought I’d really go for it).

I pointed out that if we are looking more closely at residential care we should probably move towards it by gradually increasing the care at home. Dad admits that the new flash point is bed-time, specifically pre-bed-time toileting is turning into a bit of a battle. When I suggested that this could be addressed by paying a professional to do it on a regular basis, just like we do with the morning routine, he agreed it made sense. Whether he books the extra care remains to be seen, but I took Beatta’s appearance on Christmas morning to be an indication that at least some of the advice is getting through.

It is interesting though, the reluctance to employ someone to provide care; it’s not about the money but it is about the idea of payment – as if Dad feels guilty for outsourcing responsibility. If Mum needed medical or nursing care and this was freely provided, he wouldn’t think twice about whether he was somehow shirking his duties. But why should it be that he feels squeamish about paying someone to bathe, groom and toilet his wife? We pay people to do all sorts of things that we could do ourselves (clean the house, mow the lawn, cut our hair, walk the dog) but personal care of a loved one is not so easy to monetise – turning it into a commodity feels awkward. I imagine it is similar for some people when considering childcare – do you outsource or don’t you? Are you paying for someone to look after your baby because your own job makes it financially worthwhile to do so or is it a negligible decision in terms of finance and more about the sanity of a few hours away, the cost of an escape from the unreasonable demands of a nine-month old? And why should it matter anyway? It should be the same as any other transaction but decisions around care come with all sorts of emotional baggage and guilt.

Anyhoo, back to Christmas Day… In short it was an enormous success. Four adults taking on culinary duties in an unfamiliar kitchen worked as well as could be expected, no injuries or burns were sustained, no plates thrown, no tempers lost (until we got to the after-dinner game of Linkee when my son’s competitive nature slightly overshadowed the ‘fun’ aspects of a board game) and we all ate and drank far too much.

Fifteen of us sat down to an epic dinner that pretty much lasted all afternoon, interspersed with present-opening and copious amounts of booze. Dad got stuck down at the children’s end of the table with Mum during the starter but my sister spotted the problem and we all had a swap-around – I was able to help Mum with her main course while Dad sat and chatted with the more grown-up contingent of the table (although he probably didn’t mind either way).

Memories of Mum in her previous incarnation of ‘dinner party hostess and holder of elegant soirees’ were in abundance. The dining room is enormous, converted from the original garage and testament to her great love of big gatherings. Equally the kitchen cupboards were a treasure trove of expensive appliances all designed to help create exotic and interesting dishes. My parents’ house has enough cutlery and crockery to serve fifteen people a starter, main and pudding without needing to trouble the dishwasher which is certainly not a feat that my own kitchen could muster. My sister and I kept stumbling across platters, decanters, retro tableware, blenders, food processors, steamers and crème brulee blow torches… it was like a nineties Heston Blumenthal had set up shop in there.

Mum really enjoyed her food, the transfers from sitting room to dining room were wobbly but manageable, the grandchildren opened her presents, held them up for her to see and put them away again once it was established that no response was forthcoming. There were animated episodes but no obvious trigger for any of them; baby Hugo was gorgeous; smiling and cooing in the way of six month olds but Mum was no more smitten with him than she was with the raspberries for pudding. There were a few words (mainly ‘yes’ in response to no actual question being posed) and some smiles and laughter but these appeared to have no bearing or relevance to what was going on around her. I like to think that perhaps the general happy bustle of the day was filtering into her subconscious and making its presence felt in a delayed fashion, so although we lost the direct correlation between cause and effect, i.e. baby smiles and immediately mum responds with pleasure, instead we had baby smiles, children laugh, food tastes nice, and eventually a memory of all these things converge into a feeling of well-being. Which is just as good, really.

This is likely to be the last Christmas with Mum in this house. I can’t see how it would be possible to limp on in this fashion for another year but there are many times when I’ve been proved wrong with her dementia and she may just pull a Lazarus out of the bag. Dad admitted that bank holidays are the hardest, when the weekly routine goes out of the window and enforced leisure time is thrust upon you, despite the reality that for a carer, there is no leisure time. Hopefully, for him and me and my sister and all the attendant children, husbands and in-laws, it was a good Christmas and will last in the memory for many years to come. As Dad said, when we all left on Boxing day morning; ‘It’s going to feel pretty quiet here all of a sudden.’

 

Happy new decade to all the carers and all the people with dementia and generally the world XXX