Thursday, 13 October 2016

Nigel, MND and me. 4: The wailing weeks


Death has moved in.

It oozes through doors, leaks through the letterbox, bleeds through brickwork, weeps through windows.   It skulks in every corner of every room.  It drips from ceilings and clings to carpets.   It prowls in passages and shivers in shadows.   It lurks in cupboards, the fridge and the pantry.   I see it in the swirl of my coffee in the morning and taste it as I drain my glass of wine at night.   Like a putrid smell, it permeates every part of the house and, like poison, it contaminates everything it touches.

This intruder, this unwelcome alien, has taken a seat at our table, declared its intentions and settled down to wait.   Nothing any of us can say or do will make it leave.

It is everywhere.  It besieges Nigel.  Consumes him.   Its presence is so profound that when I look at him that’s all I can see. I see its reflection in the haunted, frightened eyes of my family.   We stare at Nigel, all of us, eager to retain the image of him whilst he’s strong.   Handsome.   Upright.   We need to lock that image deep in our memories.  Before he slowly disappears.

Everybody knows now.  The news, as they say, is out. 

 It tore through the family with the destructive force of a tornado.  Now, everyone is struggling through the wreckage the best they can.   

Nigel paces so much he’s wearing a groove in the kitchen floor.   He can’t be still.  I wonder if he’s trying to escape the demons from inside his head.  If he keeps moving he’ll hold them off.  If he stands still, they’ll overpower him.  And he’ll be lost.

Craig spends every minute he can with his dad.  He’s quite unable to leave him alone for long.  Ellie, like most of us, plunged head first into the web and emerged utterly devastated.   Becky emphatically refuses to look.  She’s not ready to know. 

Les, Nigel’s brother, calls in every day.  He sits at the kitchen table, bewildered. 

‘Are they sure?’ he asks.  ‘Could they have got it wrong?’

Mel, unable to speak when she heard the news had to find the words to tell Tracey in Tenerife and their poor dad, Ron, holidaying there.  Their distance makes the news even more unbearable.

 ‘Thank God Mum isn’t still with us,’ they say.  ‘She couldn’t have coped with this.’ 

I’m not so sure.  She wasn’t called ‘Super Doz’ for nothing.

My sister Paula wakes in the middle of the night, inexplicably surrounded by Quality Street wrappers, and mum’s normally pristine house is left to gather dust whilst she too uncharacteristically devours chocolate.  My dad, who likes to think the world is kind and just, can’t believe it.   It’s not supposed to be like this.

Family and friends phone to offer us comfort and support and then phone each other in the hope of finding some for themselves.

The news sits like a boulder in the pit of everybody’s belly.  It’s heavy, cumbersome, and impossible to get used to.

Why Nigel?   How did this happen? 

If I can understand then perhaps I can handle it better.  There must be a reason.  There has to be.   Yet everything I read tells me that there is no reason.  No cause.  No trigger.  MND strikes at random.  Victims can be old, young, male or female.   The only common element seems to be that most people who contract MND are physically fit and active.   Nigel fits the profile.   Not only is he fit and active but also as strong as a horse.  Twenty years of scaffolding eight hours a day is better than any workout in the gym.  He plays golf at weekends and rides his bike every morning before starting work.  Couch potatoes don’t get this.   

We know now that the diagnosis of Motor Neurone Disease is a long and complex process.   The series of tests that eliminate everything else can take months to carry out and, to make things even more difficult; there is no single, conclusive test for MND.  Well, actually that’s not true - there is one  - an autopsy.

We’ve been surfing the net.  Devouring every scrap of information.  Desperate to find something, anything, that could ease this awful reality.  They really should tell you which websites to study when faced with such a diagnosis.  Most sites seem determined to terrify you.  One of the best, the ‘Motor Neurone Disease Association’ website, supports you through the nightmare in a constructive way.   It talks about ‘living with MND’, not dying from it.  It even warns you not to click on a link if you don’t want to know the prognosis.  It offers inspiring stories of fellow sufferers.   It offers support and encouragement. 

But it doesn’t offer hope.

Despite that we’ve joined the association.  Not a club we’re desperate to be members of but when you are lost and somebody hands you a map you take it.  They’ve sent us a file.  It’s worryingly like a welcome pack.  It screams:  ‘get organized.’   There’s a section for listing the myriad of medical professionals who will suddenly form part of our lives; a section for all the equipment Nigel will ultimately need – stuff we didn’t know existed; a section  for communication; one focusing on the difficulties of eating and drinking and finally, ‘end of life decisions.’  That section is missing.   Mistake, or tact?  I wonder.

I shove the file in a cupboard.  Not actually ready for that world yet.  Maybe later.

We’ve had our first visit from the Hospice nurse. 

‘Would you like to come and have look round?’ she asks.

Er … no.

Not ready for that either.

‘I want to die at home,’ says Nigel as he calmly sips his tea. 

‘Of course,’ she says, making a note, ‘we will help you with that.’ 

Are all our conversations going to be this weird from now on? 

In the absence of hope, you look anyway. 

I found one story on the net – ‘Eric is winning’.   He claims that total detoxification and masses of vitamins is the key to beating this appalling disease.  He goes so far as to recommend having all your fillings removed.  The mercury, apparently, is not at all good for you.  Whatever he did, it had him walking again, he says.  I’ve bought his book.  I’ve vowed to stock up on vitamins.  I’ll try anything. 

MND is a creeping paralysis.    Nigel’s muscles will deteriorate until he can’t move, speak, eat, or breathe.  We don’t know the route it will take.  There is no predictable pattern.  Everyone is different.   The websites talk of ‘personal journeys’ like you’re setting off on some kind of holiday.  Some people first lose the use of their legs, some their arms.  Others, totally lose the ability to speak, but can jog around the park for years.  Some drop dead before their limbs are affected at all.  It could take as little as six months or it could take years.   More than fifty percent of people with MND die within fourteen months.  Nigel’s lucky then.  His prognosis of three to five years is as good as it gets.  Whatever the timescale, the outcome will most certainly be the same: death.

I’m not sure I can do this. I’ve never been tested.  I’ve had a life free of tragedy.  I’m afraid – pathetically so.  I can’t even say the words ‘Motor Neu…’ without tears clogging my throat.   Unable to perform anything other than basic functions I’ve got myself signed off from work.  

Each day starts like waking from an anesthetic.  I feel numb, confused.   Familiar things seem unfamiliar.  My muddled mind searches for memories of yesterday - something that can clarify today.   

Death, having stolen the space in the bed between Nigel and me, says, ‘Good morning.  Did you think I was just a dream?’

And then I remember.

I’ve taken to hiding behind the settee.   The smallest space I can find.   Room only for me.   Nothing can hurt me here.   Nothing can find me.   Just as monsters can’t find you beneath the duvet, I’m safe.  Not even death would think to look for me here.    And anyway, death is busy.  It’s just left - gone to the pub with Nigel and Craig to watch the rugby.    Craig is no fan of rugby and no fan of the pub either, but the need to be with his dad is greater than what he dislikes.  Perhaps if they do normal blokey things they can share some special time and keep the killer away a little longer.

The doorbell rings, but I ignore it.  I’ve locked the doors deliberately.  I don’t want to see anybody.  I want to crouch here, behind the settee, and press my face into the carpet.  I want the strange and woeful noises that have been smothered deep within me to erupt at last.  My throat can’t hold them captive any longer.  I can’t swallow any more sobs.  I need this time, this hour, to let it all out.  I need to wail.

There’s been a fair bit of wailing these last few weeks - amongst us women at least.  Not quite akin to Jews at the Wall, or the howling display of grief common in Islamic and Arabic cultures, or even the keening of the Irish and Scottish, but a typically English expression of collective grief, following a great deal of alcohol. 

When Nigel and Craig return it will be time for me to regain control.  Time to plant the smile back on my face, time to pretend that everything is going to be all right.   Ellie and Becky will be back by then and we’ll sit around the kitchen table, eat a takeaway and drink some wine.   We’ll drag up long-forgotten family memories, laugh a lot and probably end up singing Pink Floyd songs, accompanied by Craig on keyboard, deep into the night.  We will talk about everything except MND.  We will enjoy each other’s company and refuse to allow that intruder to spoil our time together. 

We will be strong.  Like Nigel.

The extent of that strength has surprised even me.  Not a single tear has he shed.  Not one outburst of anger, not one indulgent second of self-pity.  No ‘why me,’ ‘poor me’,  ‘life’s not fair.’  Always the realist, he is as accepting of life’s disappointments as he is grateful for the joys.

‘Everybody gets a kick in the bollocks at some point,’ he says, ‘this is mine.’

He has set about sorting things out.  Already some major decisions are made. All his life he’s wanted an earring but been too macho to admit it.  Well, now, he’s having one.   A Jag too.   Always fancied one of those.  Oh, and a poker trip to Vegas.   Why not?  Not too extensive a bucket list by any means.  A good start.

Thanks to the support of Glyn, his business partner, he has decided to give up work.  He plans to play golf every day for as long as he can.  The critical illness claim is in.   A meeting with the accountant is logged the diary.   There’s only one agenda item:  ‘what happens now?’    

He is preparing to face the future the only way he knows how.  Head on.  Directly.    I believe he is facing it bravely, and with heroic resolve.  He disagrees.  He says there is nothing brave about it.  He says he simply has no choice.

In contrast, I have stepped, tentatively, into this unfamiliar territory.  Like walking on quicksand, each faltering footfall feels perilous.   It is Nigel who guides me, and the rest of us, through these wretched early days.  He is the one holding us in his arms as we weep.  He is the one who can still make us smile as he cracks impossibly unfunny jokes when each family member visits for the first time after hearing the news.

‘I’ve just been dying to see you!’ he quips, when my brothers come. 

We laugh, in spite of ourselves, and feel just a tiny bit better.

After thirty-two years of loving this man I am falling in love with him all over again.   The journey he is about to embark upon promises to present him with unimaginable challenges.  Along the way he can expect to lose the ability to do everything that he loves to do.  The path he will follow may plunge him to depths of despair that will test even Nigel’s unconquerable spirit.   The road may lead to intolerable torment and unspeakable suffering.

But wherever this journey takes him, he will not be alone.  I will be by his side. 

I will be with him every single step of the way.





















Thursday, 29 September 2016

Nigel, MND, and me. 3: How to break the news?




And so it begins.    Life with MND.

Funny how you can still behave normally, even though your world is shattered. 

We leave the hospital and call, as planned, at the accountant’s.   Why we call I have no idea.  Following such devastating news, shouldn’t we be doing something else?  But what, exactly?  What are you supposed to do when you have just been told you’re dying?   There are no instructions, no guidelines to prepare you for moments like this - no recognized conventions to lead you through step one, two and three.

Thankfully, John isn’t at his office.  I’m relieved.   I’m not ready to talk to anybody and I can’t imagine that Nigel is. 

We sit in silence in the pub, holding hands.   We must look like one of those married couples that have run out of things to say.   Nigel stares at his pint.  Disbelief swims in his eyes.   My glass of wine grows warm in my hand.

‘Do you want some food?’ he asks, after a while.

I shake my head.  I couldn’t eat a thing.  The lump in my throat is choking me. 

Nigel brushes away a tear from my cheek with his thumb.  The tender gesture prompts more.   He smiles, reassuringly, squeezes and pats my hand.   Both of us are struggling to find the right words - any words – right or otherwise.   I feel awkward, almost nervous.  

‘We’ll be okay,’ Nigel says quietly.  ‘We’ll get through this.’

I nod in agreement, but I’m lying.  I feel as though I’m standing at one end of a collapsed bridge.   I can see the other side, but there is nothing but infinite darkness in-between.  Instinctively, I know I have to move from here to there.   I must somehow get over that void.   The life we know is finished.  It slammed to a stop an hour ago.  To start the next, this strange, frightening new life, I have to find the courage to step into the unknown. 

Nigel has already taken that step.  The numbness has worn off and I can almost hear his mind making plans.  The clenching and unclenching of his jaw signals to me that he’s preparing to take this thing on.   There is going to be a fight. 

I replay in my mind the last hour spent in the consulting room.  

‘How long have I got?’ asks Nigel, getting straight to the point.

‘Three to five years,’ comes the reply.

The self-control that Nigel displays throughout the consultation comes as no surprise.   He’s not a man prone to histrionics.  Having said that, given the nature of the news, even the most theatrical of drama queens would have been stunned into silence.  Neither does it surprise me when Nigel talks about his critical illness insurance policy.  It’s not unusual for money to be amongst his top priorities.  No doubt he is thinking how we would manage if he can’t work.

Mr. Harrop writes a prescription for the only medication on the market for MND.  It extends life by two, possibly three months.   Awesome, I think , feeling wholly unimpressed.  He would be contacting our GP and all appropriate health professionals.  We could expect to hear from a Physiotherapist, Occupational Therapist, Speech Therapist and someone from the Hospice. 

The Hospice?  That’s for dying people.   It can’t be true.  Look at him, my invincible husband, so strong, so fit.  He can’t be dying!

And as if to confirm my belief, Nigel interrupts my reverie, downs his pint and quickly gets to his feet.  ‘Come on, we’d better get back.’  

Glad of the distraction, I follow him to the car.

The car phone is ringing.  We can see on the display that Craig is calling.

‘Don’t answer it!’  I panic - we haven’t yet discussed what to say to the kids.  Too late, Nigel has already pressed answer.

‘Hi Craig.’

‘How’d it go?  Everything alright?’

‘More tests.’ 

‘Bloody-hell.  More?’

‘Yeah.’

‘What are they testing for, for fuck sake?’ 

‘Dunno.  Eliminating stuff.   This ‘n’ that.   No big deal.’

 ‘Mmm.’ Craig sounds unconvinced.  ‘Oh well.   What you doing when you get back?  You off to the pub?’

‘Yes, just setting off now.   We’ll call at the Indigo for one.’

One?   

‘Right, see you tomorrow, then.’

I’m not sure how helpful it is misleading Craig, but at least Nigel has bought us some time. 

So, tomorrow it is.  Everyone will get the news tomorrow.

I don’t know why I imagine that there’s some protocol on who gets bad news first but I decide that we really should make sure the kids know before anybody else.

‘How are we going to tell them?  The kids?’  I ask.

‘We tell them straight.  There’s no other way.  Can’t dress it up to make it any better.’

No surprise there either.  Nigel is a practical, candid, realistic man.   Nobody is ever left in any doubt about what he thinks, says or means.   There is nothing ambiguous about him - a characteristic that can be as infuriating as it is endearing.  

‘Yes I know, but I wish we could do it face to face.’

‘Not possible.’

He doesn’t need to say it - I know it’s impossible.   We haven’t been together as a family since New Year’s Eve.  That’s how it is with one daughter married to a soldier and another in the RAF.  At least Craig and his family live in Scarborough so we can hopefully tell him in person.  I suppose we’re lucky that the girls are even in the country at the moment.

‘We’ll ring them tomorrow.   Then they’ll hear it from us rather than anybody else.’

He’s right of course.  I nod and bite my bottom lip to contain the sob that’s trying to escape. 

‘Don’t worry, they’re not made of glass.’

No.  No they’re not.  They’re much more fragile than that.

If I’m honest, it’s not so much the act of breaking the news that is worrying me the most; it’s the news itself.   I realize, of course, that there is no such thing as a pleasant terminal illness.   How could there be?  But this disease, this MND, makes even doctors shudder.  It is quite possibly as unpleasant as it gets.

I close my eyes and rehearse what to say in my mind.  

‘Motor Neurone Disease?’ they’ll say.  ‘What’s that?’

I doubt they will have heard of it.   It’s rare.  Not like cancer.  Not something you hear about almost every day.

Nigel certainly hadn’t heard of it. 

I saw the puzzled expression on his face following the diagnosis.  That not particularly worried, questioning look as he waited for the Neurologist to explain exactly what this thing is and the recommended treatment plan: 

 - A course of medication, a little operation, a touch of this, a touch of that.  You’ll be right in no time…

 No, of course, he’d never heard of Motor Neurone Disease.

But I had.

And since hearing Mr. Harrop say those three dreadful words, the memory of a documentary I watched years ago has forced its way back into my consciousness and steadfastly refuses to leave. 

I had made a cuppa in anticipation of the programme that I was actually interested in – something senseless like ‘Who wants to be a Millionaire’, and I happened upon that week’s Panorama as I settled down to wait.  I can hear again the thoughts that flooded my mind, as I was held, captivated, by those images, as clearly as if they were being screened in front of me right now.

She’s only slight  - just a tiny little thing.  Looks a bit odd. Kind of crooked. 

They seem to be making a job and a half of getting her out of that chair.   She can’t be heavy can she?  Two of them – struggling with her.  Hope they’re not hurting her.  She’s a dead weight.  Can’t help them.  She can’t move.  Must be like she’s made of lead.  Just look at her, poor thing. You’d think there’d be some kind of lifting equipment for people like this.  Surely?

Oh, what was that awful noise?  Is she speaking?  My God, she sounds like a trapped animal wailing in fright.  I’ve never heard such an agonisingly pitiful noise.   The desperate woman must be brain damaged.  Got to be.  I’m amazed they can understand her at all. 

She must be in pain.  Listen to her! 

Oh I can’t watch.  This is shocking.  She’s drooling.  But that must be her husband.  How lovely – how tenderly he’s wiping the drool from her lips. He must love her so much.   This is heart breaking.

She must have had a stroke.  Definitely.   Must have.  

Ah, no, not a stroke, … Motor Neurone Disease. 

Whatever that is. 

I see … extremely rare, apparently.  Of course! – That’s the Steven Hawking thing isn’t it?

Wonder how old she is?  Fiftyish?  She looks so very, very tired.

Just look at the poor buggers. 

She wants to die.  Been campaigning for months.  Wants to die with dignity, at home.  She wants this misery to stop.

Hell, you can’t blame her.  Who wouldn’t?   State she’s in.    I would.  Unbearable.

She wants a doctor to be able to help her, but the courts won’t allow it. 

Bastards.

What must it be like to suffer like that?  Can’t begin to imagine it.  The entire family must be devastated.  Poor wretches.

Thank God this kind of thing only happens to other people.

 - Not people like us.

I remember the horror I felt at the awful sound she made as she tried to speak.  It haunts me still.   I remember that feeling of unease mixed with overwhelming pity as I witnessed such a profoundly personal tragedy.  But, now, mostly, I am filled with shame.  How could I sit there, waiting for some ridiculous programme, utterly convinced that the helplessness and despair unfolding before my eyes was the kind of suffering experienced only by others? 

Only happens to other people, I’d thought.  Not people like us.  Nothing like that could ever happen to us.

But it can.  It is.

It is happening to us. 

It’s happening to Nigel.

I look at Nigel as he drives.  His handsome face, concentrating on the road.  His hands, gripping the steering wheel just as lightly as necessary.  He drives smoothly, swiftly,  competently.  How long before he can no longer drive?  How long before he can’t walk?  Can’t move?  Can’t actually do anything?   How much time have we got before his body becomes useless, withered and utterly destroyed by this disease?

How long before Nigel’s speech is displaced by those haunting, anguished, unintelligible sounds? 

And will he, like the pitiable woman in the programme, reach the point where his torment is so intolerable that he longs for death?  Will he be able to make the choices that she was denied?  

An hour ago our greatest concern was what we might choose for lunch.

Could it really be true that, now, this is our future?

Yes, it could. 

So … how do we tell the kids?