The Germans say that a person has learned much who has learnt how to die. In my line of work as a nurse, death is one dull dreary experience and I have interacted with it several times. My colleagues and I are always fighting it on behalf of our patients. The statistics have so far been overwhelming in our favour. Sometimes however, the thin curtain between life and the other side gets lifted and it is bye bye.
Never before in my career had death become all too familiar as when I started working with residents. The beauty of a close knit care home is the homely atmosphere. Everyone knows everyone. Some residents know the team and they can tell who didn’t come to work when. It is also very hard not to have some degree of emotional attachments with them.
Good nursing practice says to empathize with clients. This calls for walking a mile in their moccasins for a nurse to offer quality care. I wore pair of Maddy’s* snub-nosed blue shoes and they fit snugly. I didn’t didn’ttake a mile in them. I completed the whole race track and loved it. This 98-year old golden girl from Swansea leapt off the page like a catchy headline.
She had been living in the advanced dementia unit I worked in for an year before I was transferred there. I do not understand my nursing journey oftimes and I gave up trying. I had hoped to work in the special nursing unit but by some twist of fate, I was posted in the advanced dementia unit.
Mental health nursing, psychology and indeed psychiatry never tickled my fancy in nursing school. The memories I have are of my team and I at Mathari Mental Hospital in ward 6B where I had a glimpse of what diminished mental faculties can do to someone. It weighed heavily on my spirit like a little baby elephant and I eliminated mental health nursing as a career.
Indulge me a little. On our first day at the aforementioned ward in Mathari mental and referral hospital in Nairobi, Kenya, we met Ndung’u*. Thin as a string with eyes that could light up a room, he tried to be invisible most of the times. Ndung’u had perfected the art of being inconspicuous. In a populace of all types of mental illnesses, it paid to not be visible for the others. Whether this was a mannerism from him or an adaptation, we will never know.
He however chewed his tongue whenever he was not eating or talkingto the voices in his clean shavenhead. You could hear him chew his tongue. The whole world could hear him chew the tongue. Ndung’u approached Mary*, one of my group mates and said ,”sister nipee.” We were greenhorn student nurses wondering who we had wronged for us to be thrust in to a such a ward.
Perhaps having seen the scene that was about to be created a few times too many, the nurses on duty smiled as Ndung’u asked for this mysterious object from Mary.
We didn’t even know how to communicate with mentally ill patients leave alone give them stuff. In Kenya, mental illness is frowned upon. Schizophrenia to be specific is not even a mental illness; it is the result of witchcraft. Either that or the good ol’ mama and papa pastors will attribute it to a few episodes where the patient forgot to tithe.
This is the culture we were coming from. Theory in class had dispelled a slither of that belief but this is a reality that even the most learned need to grow into.
Ndung’u was adamant that Mary needed to give him something. With open palms that revealed dark undergrowth under the fingernails, head hung expectantly on his side and those pleading big black eyes, he paused from chewing his tongue and took his voice a decibel higher.
“Sister nipee, Sister nipee, Sister nipee!”he impatiently exclaimed. Mary asked Ndung’u what it is that he wanted as the rest of us tried to be cowardly strong behind Mary. We had heard tales of students getting beaten by the patients and nobody wanted to provoke anyone. Silent lambs in a lion’s den.
Ndung’u quipped like a baby by its mum ,” nipee kanyonyo kamoja. Niwekee hapa (pointing to his palm) nifinye.” Fellow patients laughed. We laughed. The nurses laughed. Ndung’u didn’t.
That awkward moment made me abhor mental health as a future area of speciality. Finding myself therefore in an advanced dementia unit was not going to be fun. Maddy changed it. At 98 she still believed in exercises. She liked stretching in her bed though it was almost impossible for her to do so. Age and other short stories.
It was my role to encourage her and help her complete her morning ritual.This was followed with a ,”cuppa nice, cold water.” Which she hungrily downed as the folds of saggy, wrinkled skin on her Caucasian face danced to every gulp. Maddy , though weak, used her Zimmer frame to use the toilet. She knew when she wanted to go and she was the most helpful resident I’ve ever met.
On this particular day, after administering medications, her alert-mat buzzer went off and I knew she had woken up.Maddy woke up every day at 9.30am. She was a clockwork. The mixed type of dementia had not taken that away from her.
The carers, N* and J* were with another resident and Maddy couldn’t wait. She was a high falls’ risk and that explains the alert-mat buzzer system. This alerted everyone that she was up ready to rock then roll.
“Good morning Maddy,” I pleasantly greeted.
“I want to wee-wee” she replied. She always said that whenever she wanted to have a short call.
Pushing the alert mat under the low profile bed, I silenced the alarm and stabilized her onto the Zimmer frame as we trudged to her toilet. She had partial sensorineural hearing loss and it was hard sometimes for her to hear what anyone was saying. She was too sweet however, that she always filled in the gaps the way she wanted; to fit the context.
Either that or my accent betrayed me. Ha ha. “Are you from Swansea?” She asked when we were having a shower. “No Maddy I am from Nairobi, Kenya” I reassured.
Maddy: Oh Swansea near the church? I am from Swansea too.
Me: No Maddy. Nairobi. Kenya. Africa.
Maddy : You should take me for the mass today. They sing good music. What’s the name of your husband? I might have seen him at the church in Swansea.
Me: Maddy (increasing the cadence of my voice, somehow adopting a British accent) I am not married. Do you know of a good man around? (I teased)
Her sunken ash grey eyes lit up. She must have managed to hear what I said. She looked at me long and hard as I oiled her lanky legs and declared, ” you have a medium bum you should get a good man.”
I know I’m not supposed to laugh but that sent me rolling on the floor. She joined me in the laughter and started a sing song ” medium bum, medium bum, you have a medium bum”
Maddy : Margaret has a medium bum.
Me : My name is Catherine not Margaret.
Maddy : Margaret has a medium bum, medium bum…
Oh well, you can’t say I didn’t try, right?
Maddy spent days in the lounge or in the garden or simply lying on her bed. She enquired frequently about the days of the week and no matter what you said, it was always a Tuesday two seconds later.
Tuesdays were pension days and she loved going to the post office to collect her pension.
Even having lived with mixed dementia for a few years, she never lost her bourgeoisie. She wore well-pressed attire complete with matching shoes. Her daughter Sheila* always provided these. She would never leave her room without her white pearls dangling from her slender, furrowed neck. This would be accesorised with a hand bag which she called a carrier bag and a pocket of disposable tissues slipped under the sleeve of her sweater of the day. Our prim and proper Maddy from Swansea.
Staffs new and old adored her. She had a kind or funny thing to say about anyone or anything. A carer could be tucking her in bed at night and she would enquire when the carer was going to bed themselves. She would offer us to sit and eat with her at meal times. She didn’t understand why we kept walking about and helping other people eat!
On the day she complained of rigors, I had spent a few hours of my day with her. Palms feathery and mild as the clouds, I lifted them to my masked cheeks and reassured her that we were doing everything in our power for her to be alright.
Earlier in the day we had had a loving conversation.
Maddy : I wish it was summer already
Me: Summer is here Maddy and I’d love to take you to the garden.
Maddy : (at the top of her lungs) There’s a tiger in the garden!
Since December last year her health had significantly deteriorated. The dementia robbing her of what magic of life was still within. Her ability to perform a few of her own duties totally impaired. She couldn’t stay in the day lounge with other residents without falling asleep ten seconds later. I believe as we age, so do we want to take naps.
She sometimes would manage to break through the fogginess of this abysmal cloud of mental decline and express herself. Our Maddy was still in there somewhere.
This was one such day and I’m glad I held her hands in my gloved palms and listened to her. I still feel the heat of her palms piercing through my face mask. She pushed away her teddy and clutched her baby pink soft blanket and told me just how cold it was. This was the only time I saw her in tears. It ate at my heart and I couldn’t wait to have the antibiotics Dr.Jill* had prescribed over the phone ( thanks to the fear and restrictions surrounding Covid-19 pandemic) ; and have Maddy start on them.
The paracetamol I had already given her was yet to kick in and she was having it very rough. Maddy was coming down with a chest infection and I had proved it through a set of vital signs and a phlegmy cough that I had not witnessed all day until now. Until now when the sun was hauntingly lingering in the British summer skies daring man and beast to move. It harshly bounced off the walls of the care home and flatteringly kissed the petals of the snowdrops that shyly looked to the ground.
Though on End of Life Pathway, Maddy’s demise broke my heart in a million little pieces. I never got to be there with her as she passed on. She transitioned to the other side on the very same day I got my Covid-19 positive results.
Yesterday I went back to our unit’s gallery. I saw her. She held her teddy and with cheeks as bright as her soul, she smiled. From her heart, she smiled. I fingered this photo of hers with immense nostalgia. I caught a tear that threatened to ruin the lapel of my uniform. I missed her once more.
It is a habit that photos of deceased residents get discarded after a while but I don’t see Maddy’s going anywhere. She was loved by staffs and relatives alike. She was loved for her nimble thoughts when they happened. She was loved for her witty sing songs.
She was loved even when the fangs of dementia clutched her brain and rained painful hallucinations on her. This golden girl from Swansea was loved even when this dying and jaded cold stare of Covid-19 robbed us of the little time we had left with Maddy.
* Names have been changed to protect identity of the mentioned people. This is for confidentiality purposes.