A human condition, p.19
A Human Condition, page 19
“That’s a long time. You’ve probably held onto an outdated picture of him in your mind and then elaborated on it over the years. I’m sure he’ll have changed. Perhaps he won’t spark the same feelings as before.”
Marion hoped that this would be the case.
*
Marion heard a tentative knock at her door. She was munching on a tuna and sweetcorn sandwich, so had to chew quickly and swallow before calling, “Come in.”
Laura, the current medical student attached to the practice, put her head around the edge of the door. She was fair and slight and spoke with a strong Northern Irish accent.
“Dr Wallace, you said you’d be OK to meet up after lunch?”
“Yes, sure. Come on in, I’m running a bit behind, still writing up my visits. Can you give me a few seconds to finish this? Then I’m all yours.”
Laura settled herself into the chair that was placed beside the desk for patients and began to flick through some papers she had brought with her while Marion resumed tapping on the computer keyboard and chewing her lunch. A few minutes later she minimised the screen, wiped her hands on a tissue and swung her swivel seat to face her visitor.
“So, tell me how you got on.”
The practice accommodated third year medical students for a month at a time, giving them an introduction to general practice. During their attachment they had to complete a small project. There was a list of suggested topics, or the student could follow a theme that interested them. Laura had chosen to look at problems encountered by families with a relative suffering from a chronic health condition. Hari, who mentored the students, had asked Marion if she could think of any patients who would be happy to talk to Laura and she’d suggested Mr Dickson, whose wife remained in Liberton Hospital, and Mrs Thomson who was still nursing her husband in their dining room.
“Well, both of the relatives were very happy to see me and have a chat. Mr Dickson was delightful, really courteous, an old-fashioned gentleman. The focus of his day is the visit to see his wife, although he does take one day off; apparently a cousin visits on a Wednesday. His son drives him there on a Sunday but on the other five days it’s a complicated journey with two buses and a substantial walk. I did it myself when I went to see Mrs Dickson; it must be very tiring for a man of his age and he goes in all weathers too.”
“Did he complain about it?”
“No, not one bit. He said he has lots of time and he wants to spend as much of it as he can with his wife while she’s still with him.”
“And how was Mrs Dickson? I haven’t seen her since her second stroke.”
“She seemed quite contented and smiled a lot; she’s not able to talk. Though the whole time I was there she clung onto my hand really tight; I almost had to prise myself free when I went to leave. So maybe there’s a bit of anxiety underneath.”
“And what did you make of the Thomsons?”
“Mrs Thomson was exhausting, just full of nervous energy and babbling non-stop. She wanted me to know how well she was coping and how wonderfully everything was going.”
“Did you think she was well in herself?”
“She looked very thin and worn out.”
“And Mr Thomson?”
“He was pretty dozy, he opened his eyes once or twice, but I’m not sure if he knew I was there or who I was.”
“So, what were your conclusions?”
“Well, when you first described the different situations, I thought that the patient being at home must surely be the best outcome. After visiting it looked as though both of the invalids were well looked after, and that both of the spouses were worn out, Mrs Thomson probably more so. So now I’m not so sure.”
“Of course the ability to cope depends on each person’s character but I worry about how long Mrs Thomson can keep this up for. There’s no way of predicting Mr Thomson’s life span, he’s been back home for about three months now. She’s doing a marvellous job, but at a cost to her own health. However, she wasn’t at all happy when he was in hospital and we have to support her as well as we can. Do you have some other families to see?”
“Yes, I’m going to see the Gourleys tomorrow. They have a teenage boy with cerebral palsy, and also the Smiths. Mrs Smith has MS. I think that probably four cases will be enough to write up and compare.”
“Good. I’m sure Hari will keep you right.”
“Thanks for suggesting the cases and for checking that they’d be happy to see me.”
“No trouble. What are you up to this afternoon?”
“I’m sitting in with Dr Choudhury for his surgery, so I’d better be getting along.”
Marion smiled at the young woman as she left. She pondered over the ‘home’s best’ argument. It seemed to her that often there were no ideal options and so you just had to choose whichever solution appeared to be the least bad.
Nyaga
K6, *yfwd, K2tog, K4; rep from * to end.
Nyaga began to knit another row of the lacy white cardigan intended for Rose’s baby. Nyaga was convinced that the baby would be a girl but if Rose knew, she wasn’t giving it away. So she was sticking to white wool, although this pattern had a row of eyelets underneath the yoke where a pink or blue ribbon could be threaded later, once the mystery was revealed.
When she’d finished the row, Nyaga looked at her watch. She should make a round to check on the residents in another five minutes. She enjoyed the night shifts at Hilltop. The atmosphere was hushed and there was an aura of warmth and security. Occasionally a resident would wander and she’d lead them back to bed, or if they were wakeful she’d make them a cup of tea or hot chocolate and chat to them for a while. There were a lot of toilet calls but there was another staff member with her, so between them they could easily cope.
She got up now and began her round. She knocked gently on each door and then entered quietly. In most rooms there was only the sound of snoring or deep breathing. Nan was awake but didn’t need to use the toilet or want anything to drink, so Nyaga tucked the downie snugly around and tiptoed out into the hall. When she returned to the office Tracey, the other helper, was there.
“All OK?” she asked.
“Yes, all quiet. Nan is awake, but didn’t want anything.”
“I’ll pop in on her again in a wee while.”
Nyaga picked up her knitting again.
“When’s your friend’s baby due?”
“In about three weeks.”
“Did you ask the boss yet about chumming her?”
“Yes. She was very good about it and said that if necessary she’d come in and cover for me herself.”
“Wow, you must be Miss Popular.”
“Mmm.”
Nyaga had been surprised but pleased when Rose had approached her last week to ask if she’d be her companion during labour.
“My midwife suggested I ask a friend or relative since I don’t have a partner,” Rose explained.
“But won’t you want your mum?” Nyaga had asked.
“Well, you know, Mum’s been great. But I just feel she might be too closely involved with me to be a good help. I’d worry the whole time that I was doing it all wrong, or that she was going to take over from the midwife and tell them what to do.”
“I’m sure she wouldn’t do that.”
“Maybe not, but I might be needier, revert to being like a wee girl if she was there. I think I’d be able to be more relaxed with you.”
“Well, I’m honoured and I’m happy to say yes on two conditions. One, that I can get away from my work. It might not be easy at short notice, but I’ll ask my manager. And two, you make sure it’s OK with Marion.”
“Cool, I’ll speak to my mum. And I hope you won’t regret saying yes, I’ll probably be a nightmare. I’m beginning to get really scared about it all.”
“Every woman is nervous.” Nyaga had tried to be reassuring. “I’m sure you’ll do just fine.”
Nyaga’s life had changed completely since the beginning of the year, and only for the better. She loved her new job. Dellview had been fine, but Hilltop was much smaller and also homelier. She liked the old house with its quirky rooms and elegant furnishing. The garden was wonderful and she felt that it was so beneficial for the residents to be able to walk there and to sit out in the sun on a good day, improving their mobility and getting a dose of vitamin D. She was always encouraging them to make the most of the facility.
When Marion had asked her to come and stay she’d had mixed feelings. A huge part of her had wanted to agree immediately. Who wouldn’t want to live in such a lovely environment? But she’d also had some reservations. What was Marion’s motive? Was she really just being friendly or did she think that Nyaga was some sort of a charity case? Her pride bristled; she’d insist on paying her way if she agreed to the arrangement.
“The room is empty now that Mum’s at Hilltop and to be honest I could do with the company,” Marion had admitted.
“What would you want for the rent?” Nyaga had asked.
“I don’t need any rent, but a contribution for groceries would be good. Take some time to think about it and let me know.”
Nyaga had slept on the offer and when she woke up in her flat the next morning she knew immediately that she should accept the invitation. After all she could also benefit from some regular companionship. Her life had been improved by better health, some friends, the library and a new job but this flat was still dreary and soul-sapping. She calculated a monthly amount that was less than her current rent but more than what she usually allowed for provisions. When she’d phoned Marion to agree to the arrangement and had named her suggested payment there had been no quibble from her new landlady.
“That would be fine. When do you want to move in?”
So now she had nicer lodgings and a better job. She was also earning more and paying less for subsistence. She felt very fortunate and was squirrelling away the extra money, saving for her return to Botswana.
Being so far away from home was still tough, and last week especially so as it had been Lesedi’s birthday. Nyaga had planned her strategy well ahead and had thought that she’d be able to cope OK. She arranged a shopping trip with Rose in plenty of time to post her gifts to Lesedi. Rose was very helpful, suggesting that they begin with a visit to the toy department at Jenners. Nyaga hadn’t ventured into the department store before. The building was ornate and had looked too imposing to Nyaga. She’d been intimidated, but had also reckoned that everything inside would be well beyond her budget anyway. Rose led her through the perfumed haze of the cosmetics section into the central hall. She described how special it looked at Christmas time when a huge decorated tree filled the space, stretching up to the highest gallery. The stairway down to the basement was quite grand, with wide carpeted steps and carved wooden bannisters, and it felt to Nyaga that she was entering a magical world, there were so many amazing toys on display. She could imagine how wonderful it must seem to a child’s eyes and wished that Lesedi could be there with them. It took a long time to choose something that they thought would appeal to Lesedi without it being too heavy to post. Eventually they’d settled on a girly Lego hair salon set and a cuddly Highland cow soft toy. Their next stop was Marks and Spencer to look at clothes. They chose a navy, sailor-style mini-dress with matching short stripy leggings for everyday wear and an elegant ivory party dress embellished with a scattering of beads and sequins. Of course in both shops a few baby toys and clothes proved to be irresistible and also found their way into their shopping bags. And there were several stops for Rose to visit toilets and a much-needed reviving café break.
On the day of Lesedi’s birthday Nyaga had arranged to work an early shift so that she was at home by late afternoon to speak with Lesedi on Skype. Lesedi was very excited, bouncing and fidgeting while chatting to her mum. She remembered her manners, though, and politely thanked Nyaga, saying how much she’d loved the presents that her mum had sent. Nyaga gazed at Lesedi, proudly wearing her party dress, and listened to her chatter about her party. She mentioned names of classmates from school and told her mum all about Pass-the-Parcel and another game that had involved chasing balloons. Her inability to put faces to the names of Lesedi’s new friends and not being a part of the events had made Nyaga feel rotten that day. After the call was over she’d retreated to her room and shed bitter tears. In her interaction with Lesedi she’d felt more like a benefactor aunt, not the girl’s mother.
Since then Nyaga had made a more definite plan for going home. Sure, she’d thought about it before and had mentioned to a few people that she’d like to be back home by Christmas, but now she had dates in mind. She wanted to be in Gaborone at the beginning of December in time for the end of school. That way she could attend any end-of-term concerts and sports events. Then she could spend the long summer holiday re-forming her bond with Lesedi. They might even take a trip somewhere; she should have enough money saved to be able to afford that. And once school began again in January she’d look for a job. It felt good to have made these decisions; she now had a firm target to aim for.
While Nyaga had been musing and knitting the day was quickly lightening and loud chirping and twittering from the birds in the garden could be heard through the open window. Used to living near the tropics where days were always much the same length, Nyaga found the change in the amount of daylight to be a strange phenomenon. The light from the early dawns not only roused the birds but also seemed to waken a few of the residents. She would expect to hear some of them stirring soon. Betty was often one of the early risers. Until recently she was still able to dress herself and would often appear wearing one of her colourful costume combinations looking for a cup of tea. However, on this spell of night shifts Nyaga had noticed a change. On the past two mornings Betty had emerged from her room still wearing her nightie, and with bare feet. Both times Nyaga had gently escorted her back to her room and helped her into a dressing gown and slippers before making her a cup of tea. Betty was also less chatty and there were definitely fewer of those sharp disinhibited remarks that had previously caused offence to some of the other residents. Nyaga was familiar with this diminishing of ability and fading of personality that Alzheimer’s caused, as it had happened to other residents that she’d cared for. She also knew, from Marion, that the lady of the pithy comments was yet another manifestation of the disease. Betty might have thought such things before her illness, but she’d have been much too polite and tactful to voice them out loud.
At seven o’clock Nyaga began to make another review of her residents. Some were still peacefully asleep, some liked breakfast to be brought to their room and others preferred to eat in the dining room. She reached Betty’s door, a little surprised that Betty hadn’t surfaced yet. She knocked and opened the door, calling, “Good morning, sleepy head.”
At once she stiffened, alert. Her instinct told her that something was wrong. She became aware of the sound and pattern of Betty’s breathing as she crossed the room to the bed. The breaths were rough and fast, but changing pace even as Nyaga approached. Gradually slowing, then an eerie silence as Betty’s respiration stopped. Nyaga counted. After fifteen seconds the fast breathing began again.
Nyaga pulled back Betty’s downie and tried to rouse her, although she knew from the pattern of breathing that she was unlikely to respond. She called loudly, shook Betty by the shoulder, pinched her earlobe and rubbed hard on her sternum. Nothing.
Nyaga left the room and hurried to the office.
“Something wrong?” Tracey asked noticing Nyaga’s expression and reading the urgency in her pace.
“Yes, it’s Betty. I think she must have had a huge stroke. I’m going to call Marion and the GP.”
“She was OK when I last looked in.”
“How long ago was that?”
“At six.”
“Did you go right into the room?” Nyaga asked, while dialling Marion’s number.
“No, I just looked from the door, she seemed fine, peaceful.”
The phone was ringing and then Marion picked up, sounding sleepy. It was a Wednesday, her day off, so she wouldn’t have set her alarm early today.
“Hi Marion. It’s Nyaga, I’m sorry to wake you, but you need to come to Hilltop. I think Betty’s had a big stroke. I just discovered that she’s not right. She’s got Cheyne-Stokes resps and she’s unresponsive. I’ll call the GP right now.”
Marion
The room was dimly lit. Soft light filtered through closed curtains which fluttered gently in a draught from the window which had been left ajar. A candle guttered faintly, releasing a vanilla scent. The slow movement of the Mozart clarinet concerto was playing at low volume as Marion kept vigil by Betty’s bed. She held Betty’s hand and spoke quietly from time to time as subjects came into her head. There was a possibility that Betty was cognisant and would know that someone was there keeping her company. The cyclical pattern of her periodic breathing still held centre stage in the room. At each halt Marion found that she also held her own breath, waiting to see if Betty’s respiration would resume. She’d been sitting for two hours now and there were signs that Betty was weakening. Her breaths were shallower, the hand that Marion clasped was colder and the fingertips had a blueish tinge.
Betty’s GP had arrived at Hilltop shortly after Marion, and after he’d made his assessment both had agreed that moving Betty would not be of any benefit to her. Something catastrophic had occurred in her brain, a bleed or an infarct, and it was obvious that it would be fatal. Their main aim now should be to keep Betty comfortable.
Nyaga had offered to stay on after her shift had finished, but Marion had asked her to go back to the house in order to tell Rose what had happened. Marion wasn’t sure if Rose would have heard the phone or her own departure. In this late stage of pregnancy her nights were often restless, leaving her dozy when everyone else was waking up. The chances were that she was oblivious to the current crisis. It would be better for Rose to hear the news in person from Nyaga than to receive a phone call or text message. Marion also asked Nyaga if she or Rose could alert Peggy to Betty’s condition in case she wanted to come and see her.
