In New York

In New York

Friday, 6 September 2013

Do's and Don'ts for Neurologists

We recently attended a neurology appointment at the West Middlesex Hospital. Jenny came with us. The ‘West Mid’, as most people call it, still has the power to inspire fear in Roch and in me, on his behalf. Almost three years on from the death there of our friend, Gerry McDonagh (see blog post passim 03/11/10), Roch’s anxiety about being admitted to the West Mid persists. With each visit, we seek reassurance. Has the standard of nursing care for MND patients improved? Following Gerry's death, we had been told that an information leaflet about MND and the needs of MND patients was being prepared for nursing staff and at each of our visits we have enquired about this. The doctor we see there never has any answers.

Predictably, after our appointment we were no wiser and no less anxious about possible admission. Let me be clear - we are not talking about palliative care, as such. We are talking about basic nursing care. Gerry did not need palliative care on admission on a Friday, but he needed it by the end of the weekend because he did not receive the proper nursing care when he was admitted.

Roch calls it ‘Death by Hospital’.

As a result of our visit, I have prepared a list of ‘Do’s’ and ‘Don’ts’ for neurologists.
From this, you will gain a pretty accurate picture of how our consultation went.

Basic Do’s and Don’ts for Neurologists:


Interrupt your patient
Tell your MND patient that there are worse diseases to have.
Tell your MND patient that it would be worse to have bulbar symptoms first.
Tell your MND patient to ‘stay positive’.
Tell your MND patient that you might die before them.
Tell your MND patient that you have anxieties too.
Diminish your patient’s experience of their illness.
Tell your patient you have no power to change things.


Acknowledge their fears.
Tell them you will do what you can to change things.
Do what you can to change things. For instance:
  • Find out how you can ensure your MND patient will not die needlessly, due to inadequate nursing care at your hospital.
  • Take action to start to change things.
  • Get back to your patient to let him know what you have done.  
It’s not rocket science.


Following the appointment Roch entered into email correspondence with Dr. Pearce, Consultant Neurologist at the West Mid, who has now sent us a copy of the information leaflet around the care of MND patients, prepared for nursing staff. Apparently this leaflet has been in existence for the last two years. As the doctor we spoke to was unaware of its existence, I suggest that Dr. Pearce lose no time in sharing it with the rest of his team.

We are, on the whole, pleased with Dr. Pearce's speedy response and it has gone some way towards alleviating our fears although we remain anxious.

He also drew Roch's attention to the CMC database:

"There is now a national data base for patients with life-limiting conditions known as Coordinate My Care (CMC).  You are eligible to join the registry (and I would urge you to do so) and this will alert care givers down to an ambulance level, so that all parties are informed, as much as possible, of your individual circumstances and preferences."

So we need to make sure Roch is registered on this database (and hope it functions as it is designed to do), that he is happy with his End of Life Directive and that the hospital and GP have copies of this on file. I can't say I'm filled with confidence.
I do know I have strong, supportive professionals on side, like Donna, our Hospice Nurse and Jenny, Roch's new PA but as his wife and main Carer I anticipate that it will be me in an emergency situation standing between the nursing and medical staff and my husband. Funny to put it like that, but that's how I see it at the moment - a 'them' and 'us' situation. That's not good. I clearly need more reassurance.

I do not want to be in a situation where a remark like "Wife claims husband has MND" appears on Roch's admission notes. True story.





Holiday snaps

Summer 2013
Family Time in the garden
Richmond Green picnic

Look Out Kavos!

A Venezia...

                                                  And there was the  Graduation

Proud father

O'Neill's in Dublin "Mine's a pint, Dad..."

Bushy Park Walk in July

Football season begins...

"Come on the Bees!"

Thursday, 5 September 2013

Post Holiday Blues

Roch is back in the Hospice for a respite stay. He wasn't looking forward to it, but the Princess Alice is such a lovely place and they do take such good care of him. Tom and I spent the afternoon there with him yesterday to help him settle in. Kate is in Spain for a week (booked before she knew the Hospice dates).
The last few weeks, since our return from Dublin, have been up and down for me. For both of us. We've had more than a touch of the ‘home from holiday’ blues. Maybe a week's respite will help.
It's been difficult, adjusting to the home routine again.

Picture the scene: A kitchen in West London. Mid- morning in late summer…

Man in  wheelchair, looking up from his I-Pad: “What are we up to today?”

Dejected looking woman at the kitchen table, listlessly turning the pages of last Saturday’s newspaper: “Nothing planned.”

“Oh,” man in wheelchair replies, “Back to slowly dying again then.”

 “I guess so,” she replies, stares out the window for a moment, then goes back to the newspaper.

 You get the picture.

We’re managing to drag ourselves out of it, but it’s hard. A new phase is beginning for the family. Back to reality after our holiday. Kate home from university, finding her feet again, Tom preparing to leave for his time away. We have a lot to be thankful for, I do know that, but sometimes when I watch Roch struggle to eat, when I winch him up from the toilet seat or the shower chair, when I look at him in his recliner, bony ankles sticking out, breathing through the nippy machine and trying at the same time to sip from a straw in his beer can, held to his lips by one of his children, it’s hard to feel that we’re lucky.

When I got back from the Hospice yesterday I felt stressed and sad. It cheered me to read a text from a neighbour, who wondered how I was feeling, home from dropping 'hubby' off to the Hospice. I was honest and told her that I felt stressed and sad, and she sent me some good night hugs. That meant a lot. Little things really help.
So what are the plans for the week? Well, today I was working. Yes, I know but I don't have enough annual leave left to take time this week. I have managed to swap two shifts, however. So I have the rest of the week off. I am beginning to regret arranging for work to be done in the house while he and Kate are away - but it was difficult to think of a better time. It'll be worth it, even though it means it won't be too peaceful around here for a few days. Can't sleep on, but plenty of early nights on the cards. Get this, I set my alarm for six today and slept right through it! Woke up at 7.31am. That has never happened to me since I began working for Missing People. Mad dash to work but what a great sleep! Uninterrupted. I am such a light sleeper and lately I've been waking early, even on my days off, and just getting up because I can't get back to sleep. I've gone back to filling my days with chores (believe me, there are plenty). Is this because my mind at rest can't block out unwelcome thoughts? Roch is often wakeful and I drift in and out of sleep. Sometimes he needs me to help him get out of bed, but not always. I don't feel my sleep is always restful. I feel 'on alert'. 
Having said that, bedtime is quite definitely our favourite time of day. Roch says that when we go to bed, he feels 'normal'. The DVD box-set currently on the go is 'The Sopranos' and most nights I tuck us in and we watch an episode before reading for a while. 

Anyway, tomorrow I'm all set for a real treat. A pedicure. There's luxury. I am not going to fill my day with chores. I am going to treat myself. I'll let you know how I get on...

Tuesday, 3 September 2013

A Change in Personnel

We were sorry to have to say goodbye to one of Roch’s PAs, Christian.  This is due in part to Roch’s increasing medical needs and in part to Christian’s ill health earlier this summer, which meant we had to seek a substitute perhaps sooner than anticipated. Having Christian on Roch’s team for the past year (yes, it is a year now) has meant that I have been able to continue to work part time and his punctuality, reliability – not to mention his availability at short notice – has given me extra free time and Roch companionship and help on numerous occasions. Christian stays in our lives as our dear friend and neighbour. We will always be grateful for his cheering and positive presence.
It was during my trip to Venice when Christian first became ill. At that time, Roch’s brothers were here to help in my absence but we were fortunate that by the time they returned to Dublin, the wonderful Mandy Garnett had come to our rescue. It was Mandy who brought Jenny into our lives.

Jenny is Roch’s new PA and I regard her as a Gift from God. No, Jenny, I will not spare your blushes. It’s not just that she is a nurse so that at one stroke all concern about dealing with medical needs disappears…or that she is capable, young, strong, learns fast…or that she is an excellent companion for Roch (she doesn’t take any nonsense), down to earth about the practical stuff and also sensitive to his feelings…or that she has a sense of humour and a sunny nature…or that she insists on going the extra mile to help me out with shopping, cooking, putting out the recycling, bringing in the washing…seeing to little tasks while I am at work. No, it’s because in an amazingly short space of time, Jenny has become part of our family. For the kids, she’s like a big sister, for me, an understanding friend. I know what you’re thinking. Nobody is that perfect. Well, maybe Jenny’s not perfect (I’ll let you know) but the important thing is, she is perfect for us.

A Busy August

The Trip Home

Members of the Maher Clan and friends gather at Mairt's house 

It’s been a busy August and I guess you could call it successful on most counts. Since we spoke last, we’ve been to Dublin and back, Tom has been accepted to Southampton University (loud cheers and clapping – ‘For he’s a jolly good fellow’…etc.) and we’ve had a change in personnel here. We also celebrated our 23rd Wedding Anniversary by attending a League One football match!

Now if you’d said to me on my Wedding Day that for my 23rd Wedding anniversary I’d be going to a local football match, I would have said ‘Forget the whole thing.’ But you know what? I had a good time. How things change in 23 years.

The Dublin trip went well, with everything slotting perfectly into place. The Irish MND Association came up trumps again. Back at the planning stages, I called our contact there, Tracy, to arrange for equipment loan (this year we needed more help than last, predictably). She it was who suggested I contact Muscular Dystrophy Ireland to enquire about the availability of their specially adapted apartment in Dublin’s pretty Chapelizod area. Unbelievably, they had a room with PA room attached vacant for seven nights in early August. They ask a nominal fee per night, per room. Each room is equipped with ceiling hoists, profiling beds and ensuite wet room. They do their best to make the rooms less ‘hospital’ and more ‘holiday’. The lift can be operated by a wheelchair user and the kitchen stove can be lowered for those who can cook. Kitchen and living room area are communal and we shared the facilities with a couple and their small daughter for the first few days. After that, we had the place to ourselves due to some cancellations. The place was a Godsend. Originally intended for people with muscular dystrophy only, it took them 20 years of fundraising to build. Now it is open to anyone with a neurological condition. For us it means we know we have a place to stay in Dublin for the foreseeable future. Chapelizod is an ideal location for us, situated more or less between the North and South sides of the river Liffey, so equidistant from Maher and Malone sides of the family.

Roch and the kids made the annual Maher family trip to the ancestral home in Tullarone, Co. Kilkenny, the Dublin Maher family get-together was held in brother Mairt’s house in Clontarf – even the famous poker game took place – Roch cleaned them out, I’m happy to report! The womenfolk made themselves scarce on poker night. Kate, Maura and I took the opportunity to go to the theatre. We chose Tennessee Williams’ ‘A Streetcar named Desire’ at the Gate theatre. Not a barrel of laughs, it’s true (what can you expect from Tennessee Williams?) but we couldn’t help identifying with Blanche and her sister, who were also refugees from the menfolks’ poker game – although our return to Mairt’s house was a little less dramatic!

The menfolk gather for the big game

The IMNDA had provided a ramp and also a commode chair for Roch to use in Mairt’s house. Another anxiety removed and something of a milestone passed (no pun intended…)

When our time with the lovely MDI people came to an end (and we could not have felt more welcomed by them), we moved house to the Gibson Hotel once again, where the IMNDA had once again come up trumps – a standing hoist was waiting for us in the room. We didn’t need this piece of equipment  there last year but this time around, we really could not have managed without it. Roch needed it to get off the bed, the toilet and the shower seat. Just for the record, the Gibson room for disabled? Perfect.

We stayed there for three nights and on night two, they kindly sectioned off part of the bar area for a ‘Gathering’ of our own with friends and family.

As Roch’s carer, I found our time in the Gibson most relaxing, but overall, just to get away was refreshing and profounding satisfying to prove that four years after diagnosis, we are still going back to Dublin in the summer, as we always did.

Many, many thanks to the IMNDA and MDI for making it possible – and thanks too, to Paudie, who shared the driving with me on the way over (we made it by the skin of our teeth onto the ferry!) and Mairt, who was co-driver on the journey back. Thanks guys, couldn’t have done it in one day without you.