by Dinah Latham
It was in the late 1960s that I returned to Buckinghamshire to take up my district nurse/midwife post, serving all the outlying villages on the far side of Chesham: Cholesbury, Hawridge, Buckland Common, St. Leonards, The Lee and many more; a charming area. But I was highly relieved to be allocated a car – it was a very widespread district and all hills! I somehow felt I’d made it. The career I wanted and a car!
* * *
Jim and Bobby
We turn into a shingle crescent, running parallel with the main busy road, where the row of houses stands back with large gardens to the front and rear, and where there is a wooded area shielding them from the traffic noise. The houses are large and the gardens well-manicured. Harriet moves across from examining the thin strip of woodland to sniffing around an overgrown gateway. I draw level with her, to where I can see into the garden and see the house. While Harriet forages under a nearby bush, I can see the weed-covered driveway and, set farther forward than the others, the house looking run-down and uncared for. I know that had the district nurse been driving down this road peering at house names, looking for the address she had been called to, she would have looked no further. So often it is the case that houses and gardens requiring care contain people similarly in need. It begins to drizzle. I walk on, calling Harriet and tugging on her lead.
* * *
It was suggestive of so many homes I’d visited: once splendid, upright, proud homes, where occupants were now left alone, fledglings long ago flown, often one partner having passed away, with the sole inhabitant old, frail and barely managing, probably living in just one or two rooms.
Inevitably, it seems couples are always going to downsize ‘when the time comes’, but somehow it doesn’t come, or rather they never recognise that it has already come. So often the time has come and gone, with the very thought of scaling down now seeming to be too big an undertaking. First the garden becomes too much to cope with and gradually becomes depressingly overgrown. Then the stairs become too much for one or both partners, each thinking, ‘Well maybe we’ll have a stair lift one day.’ The problem is that you have to be as nimble as the people in the stair lift advertisements to be able to get on and off the contraption unaided, which means, in reality, you pretty nearly have to be able to manage stairs to be able to manage the stair lift. After all, those lively souls in the commercials could probably leap up the stairs two at a time!
Once the upstairs becomes out of bounds, the elderly person retreats into an ever-decreasing number of the remaining rooms, while at the same time often withdrawing into themselves as well.
Moving is eventually seen as too big a task to even consider and so the once beautiful home deteriorates. There’s a sadness about the place… all its grandeur gone. The rundown appearance isolates it from the neighbouring residences, too often echoing the loneliness of its owner.
My mind wanders back to another dilapidated house…
Jim’s house had certainly seen better days. Another sad-looking, rundown home, with plywood where the glass should be in the top panel of the front door and weeds climbing over the crumbling sill of the bay window to the right of what was once a porch.
My first call out to Jim was in response to a message left by the GP (General Practitioner): “Patient too dirty to examine. District nurse please attend.” Jim was an eighty-six-year-old gentleman who lived next door to a pub where he spent a large amount of every day. He had large, weeping, varicose ulcers on both legs that required daily dressings. I did these every day in the pub snug bar for nearly six weeks, until I persuaded Jim to allow me to do the dressings at home. He was too frightened that when I saw his living conditions I would insist on a hospital admission or care home and there would be no-one to look after Bobby, a mongrel dog and his loyal companion (who drank nearly as much beer as Jim). While he was able to shuffle next door to the pub, life for him and Bobby held meaning. While washing my hands under the kitchen tap, I took a look in the fridge: half a tin of dog food lay next to a small piece of mouldy cheese. Because he could no longer manage the open fire with its back boiler, there was no hot water. A small, one-bar electric fire was sitting on the hearth. I’d never seen Jim in any change of clothes and I was unable to tell whether the dank smell of stale urine emanated from Jim or the armchair, or maybe even Bobby. Jim had long since given up climbing the stairs and so days and nights were spent here in the chair.
These were the days when ‘home helps’ were still in existence; those blessed persons who would shop, collect pensions, cook meals, walk the dog, befriend and who, alongside the district nurse, generally kept a watchful eye on those elderly persons who were just on the edge of coping, who really wanted to remain at home, but were only just managing to do so.
Meals on Wheels, a weekly bath (thankfully, Jim’s bathroom was downstairs) and regular clean clothes did much to improve Jim’s skincare and, together with some judicious continence advice, his quality of life improved; demonstrated by the smile on his face when he continued to visit the pub. This smile reflected the reassurance he felt, knowing he could remain at home and wouldn’t be ‘sent into one of them care places’ because he couldn’t cope and where he would have been forced to part with his Bobby.
I’ve always found it difficult to understand why, in the name of care, we advise, encourage, persuade, and at times insist, that the elderly go into a care home ‘for their own good’. There often appears to be so little consideration for the myriad of losses this decision entails: loss of home, familiar surroundings, friends and acquaintances, maybe the only place of rest ever known, the self-determination to eat and go to bed at will. With this loss of independence and the strength of associated feelings, we then refuse to allow them to take their closest companion, their dog or their cat, dictating that it’s not allowed. So many goodbyes, so much sadness, even anger, and no close mate to understand and to share all these changes with.
While we enact this abuse, we pretend to care. We fail at a deep level, somehow reassuring ourselves that our decision is the right one and ‘it’s all for the best’.
* * *
A beautifully snowy morning. My diminutive garden looks as well-manicured as any other when it snows; it may be a lie but I like it. I take pleasure in admiring the early blue clematis pushing its blooms out under the snow blanket draped along the high wall beyond the terrace. The wall is covered with climbing evergreens, all bowed down now with the weight of the snow that flurries down over Harriet as she brushes past.
On our walk Harriet delights in running backwards in front of me, catching the snow as it flies off the toes of my boots as I walk. We are the first visitors of the day as we head down into the wood; the virgin snow disturbed only by the bird footprints scattered ahead of us. The hilly field to the right awaits the shouts of joy from the children as they descend on their sledges; if the snow lasts, we might see snowmen tomorrow. We continue down to the footpath into the wood and as I follow Harriet’s route through the snow around the bend at the bottom of the footpath, I remember snowy winters of my own…
* * *
There was the fabulous day when thick, fresh snow had fallen overnight and Dad decided the whole road should skip lessons and he spent his day weaving up and down our road in his car with everyone’s sledge tied one behind the other on to the bumper; great squeals of delight peppered with screams of “Stop, stop!” when someone’s rope broke!
He believed in fun did Dad, and an illicit day off school made it all the more exciting.
There was no health and safety. ‘All schools close when it’s cold’ didn’t happen in the ‘40s and ‘50s. We all walked unaccompanied to school, most of us some distance, in all weathers.
The big, round, boiler-type fire, encased in its own wire cage with its huge pipe ascending through the classroom roof, would be festooned after a playtime of snowball fights with an array of wet scarves, hats and gloves – also drying there would be Sissie Bradshaw’s knickers. Presumably she did become continent by the time she
left school. It was the weather for liberty bodices kept under the bed quilt overnight, with the vest still inside; all put on while still in bed in the morning before braving the cold of the bedroom. We heated pennies on the top of the small, round paraffin heater to melt the ice on the inside of the windowpane, permitting us to peer out.
* * *
As I struggle over the stile, Harriet darts underneath, scattering snow in a cloud as she rolls over in joyful mood. There was once another snow-covered stile and another time…
* * *
I had set off on my bike in the snow to a farm out in Sussex, about three miles from the town, and most of it uphill as I remember. I’d had a call from a phone box, from a farm worker living in tithe accommodation; a small cottage right out on the far edge of a large farm. I had visited mum for antenatal checks and knew just how far out they were. With the snow settling fast and the sky looking well laden with more, I was anxious to get there. John, her husband, had arranged to pick me up at the stile because it would have been difficult in the snow for me to cross the fields carrying a bedpan, delivery bag and the gas and air apparatus. By the time he got there, I resembled the abominable snowman and was pleased to scramble up onto the tractor seat for the final part of the journey. A warm kitchen welcomed me and, having established that all was well with unborn babe and mum, and that delivery wasn’t imminent, we all huddled round the range with its roaring fire and drank tea with homemade biscuits for dunking. We continued to labour together throughout the rest of the day and into the night. It was all a bit slow but clearly progressing; this baby was just not that anxious to be born. Many cups of tea and several slices of the most delicious lemon cake later, he announced his arrival loudly, assuring us all that he had a good pair of lungs.
It was one of those good deliveries that went just the way it should: where the labour progressed slowly but surely; where confidence builds between parents and midwife, and where the wonder and joy at the birth of this new life will be remembered and cherished by all parties. I’ve only ever experienced this almost spiritual happening with a home delivery, where to share this intimacy of womanhood brings a closeness that makes the responsibility of the task an honour afforded to very few by way of the job they do.
The treasured recollection of the story is that I was snowed in and had to stay for a further two nights before the snow melted sufficiently for me to leave and reclaim my bike. With no phone in the house and snow above the windowsills, there was no choice but to sit it out and play nursery nurse. Indeed, I slept in the bed with mum, and the longsuffering John slept on the sofa and brought us both tea in bed in the morning! This event became a very special trophy for the memory bank, notwithstanding the two days’ leave deducted from my annual holiday entitlement by the then area supervisor, namely ‘she who will be obeyed’. I shudder to think what the layers of nursing management would make of such disgraceful behaviour these days.
* * *
Harriet barks, pulling my focus back to the here and now.
I say a silent prayer, giving thanks for central heating, as we start our return journey as more snow begins to fall. I can’t feel my fingers as I reach down to attach Harriet’s lead, and she gets impatient with me, snatching at snowflakes, trying to eat them all.
* * *
As we hurry on, I find other childbirth experiences fluttering through my head, together with thoughts about how very unusual it is now to find anyone who has had their baby at home.
There is always something special about a homebirth that I’ve never quite seen translated into the hospital context. Hospitals talk about birthing suites and try to have coloured curtains and birthing pools. However friendly and welcoming some hospitals have attempted to become, it can never capture the special quality of a homebirth.
We live in a society that has spent the last fifty years concentrating on institutionalising its deliveries and on frightening women into believing their very lives and those of their babies are being put at risk if they are foolhardy enough to consider a homebirth. Yet, I understand that, there are now discussions beginning to suggest that perhaps there is a place for home deliveries.
The real sadness is that we have allowed those special skills needed to manage a home delivery to disappear. We decided they weren’t needed in the modern world. The skills demonstrated by midwives, who worked in the community for so long, were disregarded, and thrown on the scrapheap as outdated and of no value. The precious art of ‘being with’ and overseeing the natural birth day has long since been forgotten.
I wonder whether those discussing its possible comeback really understand the meaning of the home delivery. During a homebirth, the midwife becomes the couple’s partner in a natural process, rather than the actively managed clinical procedure that birth becomes in hospital. I suspect that the belief held by those at present considering a return to home deliveries is that we need to convert the home into a technological delivery suite. That totally misses the point of what couples are really asking for when they choose a home delivery. The bonding of both couple and baby is about the whole birthing experience; not simply what happens at the time of the actual birth.
I’m reminded of how difficult it became during my last years of practice to hold on to the sort of death at home that people really wanted. When people are asked where they would prefer to die, most people want to die at home. When this want is questioned further, of course they want to be free of pain, which is as obtainable at home as in hospital. But more than this, I would discover that what they meant was that they wanted to die in their own bed, drinking tea out of their own cups and with their close family members beside them. Increasingly, ‘the powers that be’ with their ‘health and safety’ rules are insisting on turning the home into a hospital ward with hospital beds and hoists intruding on the image that patients and families hold of how dying at home would be enacted.
It becomes almost impossible to be unaware of how the intervention of the medical man, in both birth and death, has not only led to increased hospitalisation for both events but also in the escalation of intervention (some may say interference), particularly in childbirth. This may also be said to apply to a lesser but still significant degree, to the dying process.
Doctors deal with disease, and while it may be an overstatement to suggest that in the natural birth and death process he is perhaps superfluous, it’s a view that is worth considering if the climate for childbirth is maybe changing and a return to home deliveries is a possibility. Alongside this, the idea that everyone needs to be admitted to hospital to die is also being challenged in some quarters, with care homes being encouraged to allow residents to stay with them within the care home situation to die, rather than scrambled to A&E (Accident & Emergency) when death appears imminent.
We have turned childbirth and dying into medical procedures that take place away from the home, in hospitals where professionals manage them as procedures. Yet these two happenings are emotional as well as physical experiences in which we will inevitably all be involved and which put meaning in all our lives, and yet we have somehow been led by the nose like cattle into institutions. Could it be that the tide is turning, albeit it ever so slowly, when district nurses and midwives will, once again, be at the forefront of both of these cornerstones of care; where the art of their craft correlates so well with all their technical expertise?
* * *
We’re walking along towards the common when my attention is drawn, as often before, to a big old rectory set back from the road, with a sweeping drive leading up to the front door. It has undergone the fate of many rectories, being no longer home to the rector of the local church; he now has a more modern private dwelling. When this rectory was up for sale, I remember inwardly mourning the fact that the one thing I had never managed in my career was to own and run a nursing home for elderly care. It was never a serious career consideration because I was never in a position to be able to purchase such a property but if I had been, I would have loved it to
have been this old rectory. I wanted to call it ‘Bedside Manor’.
Harriet always snuffles in and around the border hedge here in front of the rectory. I’m never sure why but clearly there must be something of particular interest, or maybe it’s simply that a couple of years ago she suddenly dived in right here and returned with a snack-sized pork pie that had to have been discarded the night before on the way home from the pub!
The way the sun is coming up behind the building creates a silvery glow that seems to be creeping over the roof. It looks like a picture postcard as we walk by.
* * *
Mary and Ted
Mary had only recently gone into the care home; she had been nursed at home for several years until Ted, her husband, had no longer, even with our support, been able to manage at home. Mary had been diagnosed with Alzheimer’s dementia many years ago and now she no longer recognised Ted and had begun to fear him as though he were a stranger. Ted himself had begun to lose his eyesight and when he had been admitted to hospital for an operation, Mary had gone temporarily into a care home. Surprisingly, she had settled really well and seemed much less anxious and more content than she had been at home of late.
Despite this, it was difficult for Ted to decide to leave her in care when he returned from hospital. He knew his eyesight was going to continue to deteriorate and here he was, eighty-seven years old, needing to learn coping strategies for himself, yet tearful about leaving Mary to be cared for by others.
He explained how loyal Mary had been to him in the war, and how friends had come home after the war to find their wives had ‘gone off with those Yankees’. He went on to talk about his ship being bombed and spending hours in the water waiting to be rescued, thinking of Mary and how he had vowed to care for her forever.