Nigel, MND and Me. 10: Magnificent deaths

You’re back. 

I’d almost forgotten.   How stupid of me.  How could I?   

From my huge, empty and solitary bed, I watch him sleep. 

His new bed and air mattress, a medical profiling bed that allows him to change position at the touch of a button, seems, at last, to be affording him some comfort.

But once again, despite the drugs, his night was long, agitated and disturbed.   

Much like a mother tending her sick child I let him rest.  

Perhaps a little longer will mean he doesn’t wake with another of those awful headaches.

The headaches are a recent development.   I’ve never known Nigel have a headache, even after eight pints the previous night.   Now, every morning is marred by nagging, inexplicable pain that lingers until lunch. 

You will spoil everything.

We’re settled now.  We have a routine.  Procedures are in place.   This plateau where Nigel’s disease has been parked for quite some time is familiar and manageable.

We are in control of this life of ours and know exactly what to do: medication first thing; give Nigel a shower; enjoy a leisurely breakfast before accepting the challenge of the Yorkshire Post’s quick and cryptic crosswords without resorting to the dictionary or Google.  

Craig calls for a cuppa, Les might pop in.  We could even get to see Ellie and Becky now they live just an hour away.  I clean an already clean house and generally make a drama out of sorting something.  I sort stuff.  Last week it was the garage, this week it’s the kitchen, next week it will be the bedrooms.  Nigel easily loses a few hours playing on-line poker and catching up with his Facebook friends.   

We’re fine.  Happy, even.

When the sun chooses to shine, and sometimes it does, we wander along the Esplanade, sit and look at the sea, revel in the warmth.   But mostly, we watch a bit of television and invariably enjoy a little snooze.

Now accustomed to the mundane, we no longer miss the madness.   Everything we need to get through our unhurried, humdrum day we have to hand.  Every piece of kit you could imagine from cups with straws, to ceiling hoists to wash-and-dry-your-bum toilet.  We have it all.

We’re doing okay.   Mogging on.

But now, you’re back.

Here you sit at the end of Nigel’s bed, a decaying phantom, spewing your scorn, slowly drumming time with those withered, skeletal fingers.

 Tap. Tap. Tap. 

Watching.  Waiting.

Must you smirk? 

Don’t touch him.  Don’t lay that putrid hand on his sleeping face.  You can’t have him.  Not yet.

We’re not ready for you. 

The unremarkable façade of St James’ (Jimmy’s) hospital in Leeds appears unexpectedly in the midst of a maze of small, equally unremarkable terraced houses.  Pulling into the car park I defer, grudgingly, to the sat nav.   It was right after all.  I had envisaged a somewhat grander approach and a more imposing exterior for such a famous institution. 

 Ah well, don’t judge a book and all that.

We arrive at the Respiratory Unit in good time, prepared for a wait.  The letter had said to allow three hours for the appointment.   

Oh no, I think, hearing the television in the waiting area before we see it.   As Nigel manoeuvres into position at the end of a row of seats, I take one of the mandatory green hospital chairs beside him and try not to look at the TV.   Not sure how long I can contend with the insufferable Jeremy Kyle, spouting with that pompous exasperation of the intrinsically virtuous, as he belittles those hapless, track-suit wearing, one brain cell apiece, cretins, who would willingly part with a kidney for five minutes of fame.

Yet another hospital, I think, ignoring the television as I mentally count the hours we have spent in such surroundings.  Pink and green as always - a splash of baby blue detracting not at all from the array of impractical, insipid colours.   Sighing, I think back to our previous hospital appointment in Sheffield – the completion of the trial.   The lithium had absolutely no impact on MND.   Sadly, Nigel never did make it to the end of the trial on his feet.   My God, that wheelchair took some pushing up those ramps in that car park!   There must have been a lift somewhere, just needed one iota of patience to look for it.

Thankfully, my random recollections are interrupted, and we are called away just as a preposterous rant about somebody’s boyfriend having eaten her mother’s dog gets underway.

‘Hiya, I’m Leanne,’ says a vivacious nurse with a blonde bob and a bright smile, her West Yorkshire accent evoking memories of my youth.  ‘Come wi’ me will yer?’

We follow, obediently, although we’re supposed to be seeing a Doctor Edwards.

‘I’m just gonna do some tests before you see the doctor,’ says Leanne, explaining before we even need to ask.

‘Where’re you from?’ asks Nigel, probably placing the accent within eight miles.  Surprisingly easy to do in fact – the distinction between the twang of nearby towns such as Halifax, Cleckheaton and Huddersfield are significant.

‘’alifax,’ she responds sunnily.’

‘My home town.’ I say heartily.

‘Thought so,’ says Nigel.  ‘You can guarantee a good night out in Halifax.   Always end up battling though.  Usually with the bouncers.  Especially in Clarence’s.’ 

‘Yeah?  That shut down yonks since,’ says Leanne.

‘I’m not surprised.  There was this particular night, me and our kid … ‘

Setting off on a personal stroll down memory lane, Nigel starts to chuckle.  We won’t get to hear the rest of the story.  Once he starts, he can’t stop. 

Leanne, now a big fan, attaches a small peg-like device on Nigel’s ear and then quickly hooks him up to an innocuous looking machine that demands no more of him than a couple of minutes of breathing in and out.   Given the antics going on inside his head, it takes more than ten.

Next he is required to blow with all his might into some other gadget – not an arduous task under normal circumstances, but next to impossible when consumed by laughter.

I am mightily tempted to slap him round the head, but I know from experience that this will only make him worse.

Eventually, her persistence rewarded, she has all she needs.

‘I wish they were all like you,’ she smiles, and sends us back to wait.  ‘I’ll get the results to the doctor.  He’ll not be long,’

I hope Mr Kyle has dealt with the dog drama and buggered off.  Ah, ‘Heir Hunters.’   Could be worse.

Before I become too concerned about Gladys Ethelberg’s fortune being consigned forever to the government’s coffers, the lovely Leanne reappears to take us to Doctor Edwards.   Happily, cousin Cyril is discovered just as we vacate the waiting area.

In comparison to Doctor Edwards, the animated Leanne appears lethargic. Exuberance positively bursts from him, spilling over every inch of his tiny office.   An ostensibly huge, but actually average built man, he dominates with the power of his personality.    Instantly likeable, with a booming voice, infectious smile and no-nonsense manner, he grasps Nigel’s hand and shakes it with enthusiastic vigour.  

In the time it takes for Nigel to negotiate the small space, we indulge in a little light chit-chat, bemoan the weather, berate the traffic, declare that we found the place all right, though not quite believing the sat nav, and decline the unusual offer of a cuppa.  

‘I must say you look exceptionally well!’ says Doctor Edwards, directing his bark towards Nigel.

 ‘I know I do.  I am.  Apart from MND.’

‘Of course,’ acknowledges the doctor, having no difficulty at all in understanding Nigel’s speech. 

‘Which is why you’re here,’ he goes on, barely pausing for breath. 

‘You’ve been suffering from headaches I understand?’ he says, peering at Nigel over the rimless specs that are perched on his nose.

‘Yes.’

‘Well, as I suspected they would be,’ he says, waving the papers that presumably hold the outcome of the tests, ‘the results are abnormal.’

‘Oh,’ says Nigel.

‘Yes.  You see, MND has started to affect your breathing muscles.   It’s very common.  Inevitable actually.  Your carbon dioxide levels are askew.’   

Matter of fact.  Business like. 

‘Hence the headaches.’

We’re both alarmed.  Perplexed.

‘I can understand why you seem surprised by this,’ went on Doctor Edwards, reading our faces,  ‘most people expect breathlessness to be the only sign of respiratory problems, but headaches are a classic symptom.’

I glance at Nigel.  His face is impassive.  The laughter, ceased.

Breathing.   That’s pretty vital.

‘But look at you!’ bellows the doctor, standing up from his chair and coming round to stand next to Nigel.  He pats him manfully on the shoulder, ‘you’re doing brilliantly,’ he continues reassuringly, ‘for someone with MND you’re unusually strong.  My God I wouldn’t bet on my chances in an arm wrestle with you!’

We laugh.  Like you do.

‘We can help with your breathing.   We’ll set you up with a non-invasive ventilator – affectionately known as a NIPPY - which I suggest you start using for a few hours overnight, increasing a little every week.’

He might just as well have been speaking Russian.  He sees the total incomprehension on my face. 

‘Don’t worry, we’ll make sure you have the training before you go and you can take it home with you today.’

The three-hour appointment now makes sense.

Doctor Edwards returns to his seat behind the desk, leans forward on his forearms and adopts, what I imagine, is, for him, an unusually serious expression.

‘Now, I do have to tell you that not everybody can get along with the NIPPY.  It does take a little getting used to but I do recommend you persevere.  If you use it, it will prolong life.  If you don’t, it won’t.  And your life will be shorter.’

I expect a pause, to allow this information to sink in, but suddenly, Nigel says,

‘How will I die?’

It’s now the doctor’s turn to look surprised.

 ‘I’m worried about choking,’ explains Nigel, helpfully.

Until this moment I had absolutely no idea that Nigel was concerned about the manner of his death.

Doctor Edwards leans back in his chair, spreads his arms wide as if to embrace and carry us, with the confidence of one who has all the answers, along the road to enlightenment. 

‘My fine fellow,’ he bellows.  ‘I have seen some magnificent deaths from MND.  Magnificent!  Not one MND sufferer that I know about has ever died from choking.   Let me put your mind at rest.  It won’t happen like that.’

‘How then?’ asks Nigel, uncommonly insistent.

‘Failure of the breathing muscles, generally.  However, many deaths result from a chest infection such as pneumonia, but let me assure you these deaths are exceptionally peaceful and controlled.  Because we know what to expect and when, we are rarely taken by surprise.  I have to tell you Mr Casson, in many ways, you are extremely lucky…’

I can’t help but raise my eyebrows a touch.

‘… For example,’ he bawls, ‘there will be some amongst your family and friends, perhaps more than one or two, who are worrying about you, who will quite probably die before you.  They have no idea it’s coming.  You, on the other hand, can prepare.  Make provision.   Say goodbye to your family.   This is denied so many.

Well, if you put it like that.

‘And, furthermore, you know that your death will be painless because we make sure of it.

‘You make sure of it?’

‘Absolutely.  When the time comes, we will make you comfortable.’

Nigel seems reassured.  ‘Thank you,’ he says, smiling now, ‘you have made me feel a lot better.

‘You’re welcome,’ he beams,  ‘now, off you go and get your NIPPY.  And don’t forget, persevere!  It’s your friend!’

Our new friend sits on the table next to Nigel’s bed occupying the space where the wardrobes once stood.  The tubes are attached, the ‘breath in’, ‘pause’, ‘breath out’ settings all determined and fixed by our trainer at ‘Jimmy’s’ to alleviate Nigel’s current problems.   All I have to do is put the headpiece over Nigel’s head, make sure the nose pillow – cute name – is the right way up and sitting properly on his face, and turn the machine on.   No, turn the machine on first, and then put the headpiece on.   Might be worth checking the instruction manual again. 

Later that night I hoist Nigel carefully into bed.  He’s exhausted.  We both are.  It’s been quite a day.

Once lowered comfortably onto the mattress I fold the duvet around him, plump up his pillow and lift the sides of the bed.  Everything is in place and within his reach:  iPad clamped securely on the side to enable Nigel to entertain his Facebook friends; water in case he’s thirsty; extra tablets should he need them; sweets should he fancy a treat; tissues to capture the odd sneeze and the alarm, should the impossible occur and I don’t actually hear him call.  Just the NIPPY left.

I turn it on and move to fit the headpiece over his face.  Nigel reaches up and takes hold of my hand, stopping me from going any further.

He smiles, but the smile fails to flush the sadness from his tired eyes.

 ‘I started to die today,’ he says.

‘I know,’ I whisper.   

I place a soft and gentle kiss on his forehead.  And, as I do …

… the thing at the end of bed slowly grins.

Tap.  Tap.  Tap.

Nigel, MND and me. 9: Sentenced to the chair

The strident whine of the riser-recliner motor heralds that Nigel is on the move.   

‘Bathroom?’

He nods.

‘Excuse us,’ I say, placing my glass on the coffee table.  ‘Won’t be long.’ 

Not true, we’ll be an age.   No longer can anything be achieved quickly. 

‘Shall I wait until you get back?’ asks Mel, who holds us enthralled in the midst of an animated tale involving superglue and a lock.

‘God no! Carry on.’  This story is too riveting to impose a halt.  Chances are Mel will sweep us towards the spectacular crescendo before we’ve even left the room. 

‘So, when nobody was about and all was quiet … ‘

Paula obligingly refills glasses as, difficult as it is to concentrate when captivated by this fascinating fable, I slide the sling across Nigel’s back and beneath his legs.  Hopefully got it the right way up this time.   New at this, my manual handling skills are tentative and clumsy.   It looked so easy when the OT did it.

‘Can we help?’ ask Derek and Tom, almost in unison, the less than polished performance clearly a cause for concern.

‘No don’t worry.   It’s easier with one.’  Another untruth.   However, two people who don’t know what they are doing are twice as bad as one.

‘So what happened when the police arrived?’

‘Well …’

Grunting indelicately with the exertion, I maladroitly manoeuvre the mobile hoist towards what the kids have dubbed ‘Dad’s control centre.’

Captain Casson is pleased now that I didn’t wait until he was dead to refurbish the lounge.  He can command operations from his perfectly equipped post, sited with regimental precision so all essentials are within reach and from where he can oversee everything and everybody, without the bother and irritation of even turning his head. 

‘You’re joking!’

The chair, flanked by two side tables bearing the whole shebang of necessities such as man tissues, toothpicks, sweeties, medication, thermostat, fan, and an ever-present cup of tea, is on loan from the MND Association.  It is now one of the few places where Nigel feels comfortable and consequently, this is where he spends most of his day.

Just wish it wasn’t pink.  What is it with pink chairs?  Who the hell wants a pink chair?

‘And then … you won’t believe this …’

Avoiding the clamps that grip the edge of each table, the arm of one, holding his lap-top, the other, his iPad, and trying not to snag the wheels on the warren of wires that stretch like sleeping snakes towards their personal plug point in the den of extensions that litter the floor, I manage, at last, to get the thing parked and the sling attached.

‘Hurry up, I’m gonna piss meself!’  says Nigel, swelling the hilarity already present in the room, Mel’s sparkling saga having flounced fervently to its finale.

Agonisingly slowly, Nigel is lifted from the chair.

The laughter subsides.

Nigel hangs, suspended.   Dangling like a baby carried by a stork.    Defenceless.  Exposed.

Not long ago this man could swing swiftly and skilfully through scaffolding with the agility and athleticism of an ape.

Nobody speaks.

Somebody coughs.

Someone else sniffs.

An uncomfortable silence descends.

‘Does my bum look big in this?’

Raucous laughter erupts into the room, as Nigel’s perfectly timed one-liner tears through the tension bringing welcome relief to our grateful guests.

Good on yer, Nige.  Even now, as his condition worsens, his enduring sensitivity and unselfishness makes the rest of us feel better.

I lower Nigel into one of the four wheelchairs that form part of the ever-increasing catalogue of care kit that occupies space in our home.   The chairs have, or have had, their role to play in Nigel’s progressive disability.

This one, powered, compact and nippy, but not especially comfortable, is mainly used to ferry Nigel to and from the bathroom.   Having been provided by the wheelchair centre it would have been reasonable to expect the chap that demonstrated it not to shout at Nigel as if he was not only deaf but also stupid. I could only marvel at Nigel’s tolerance as he had the operational complexities of a joystick painstakingly explained to him.  Physical disability does not render a person retarded. 

Languishing unloved, banished to the gloomiest corner of the garage, covered in cobwebs and buried beneath junk, is the first and only manual wheelchair we ever bought.   With the confidence that springs from total ignorance we allowed this abomination of a carriage to accompany us on a long weekend to Brussels.   The chair is bewitched, compelled by demons to tumble into every pothole, fault and fissure – either that, or Brussels is the most wheelchair-unfriendly city in Europe. 

Or … perhaps my driving has something to do with it? 

Whatever the reason, this is when Nigel determined that his situation was indeed perilous. Subjected to the incompetence of others, however noble their intentions, is not something that he can bear.  The manual wheelchair has to go.

Apart from the fact that pushing a fourteen stone man up the slightest incline ensures half a stone of weight falls off you in a fortnight, I’m not at all sorry to see it exiled. 

A sporty, metallic blue, nifty little number also lives in the garage.  Bought mainly because of its boasting that it could effortlessly climb kerbs.  It lied.  Nevertheless, it has proved its worth by providing hours of fun as a serious contender in wheelchair races.   Sadly though, it has had its day and is now condemned to gather dust with its manual mate.  

All of which leads us to the ultimate in mobile chairs. 

‘I’m free!’ Nigel shrieks, hurtling down the lane on his way to the shop to buy a paper, as excited as a little kid dashing to spend his pocket money.   Perched atop his trusted steed – a shiny new, top of the range, can-do-just-about-anything wheelchair, he waves happily and heads off on a huge adventure.  

This chair can travel for fifteen miles; perform a perfect 360-degree turn on a tanner and assume numerous positions including a tilt and recline deep enough for sleeping.

Good as it is, further adaptations are necessary to meet Nigel’s exacting standards.  A made to measure upholstered winged back and headrest are commissioned along with two additional foam filled seats, four and six inches deep respectively.   

‘It cost more than our first house,’ says Nigel to absolutely everybody.  Proudly showing off his truly customised original lounge chair – a Queen Anne on wheels. 

For anyone unable to walk, a powered wheelchair is indeed liberating.  With the right equipment, disability need not be at all limiting.  

But MND is more than disability.  

As I watch him disappear round the corner, I smile at the degree of pleasure he will derive from this simple trip to the shop.  What am I saying?  He won’t just go to the shop.  If I know Nigel he will drive the chair up the steepest hill he can find to test how fast he can career down it.  When he’s conquered that he’ll see how sharply he can tackle corners without toppling.   He’ll drop it off the kerb into the road just to see if it gets back up.

He may very well head for the path alongside the golf course and playfully hail a former combatant to put him off his stroke.  He’ll think back to the day he got a hole-in-one on the par four, in spite of, or possibly because of, the hangover he was nursing. 

Possibly, he will head in completely the other direction, crossing the Spa Bridge into the centre of town.  His chair could very well earn its battle scars by engaging in a less than friendly joust with the myriad of menaces mounted on mobility scooters.   He might barge bullishly into stores, toppling tins, crashing into crockery and colliding into clothes.

He could even scurry to the Skate Park, riding the ramps before those trendy teens in a tantalising display of slick tricks and mighty moves. 

He’s bound to bump into old acquaintances and even encounter some new ones.  He’ll smile and share a joke, tell them his chair cost more than our first house, and add them to his ever-increasing circle of Facebook friends.  

If he comes across a gang of scaffolders erecting or dismantling a scaffold, he’ll laughingly tell them they’re doing it wrong.  They won’t be offended.  They’ll know him.  Every scaffolder does. 

He will do all this because he’s Nigel.   He will always be Nigel.   No matter what this disease does to him.

Bit by bit, MND will steal his body and ultimately, it will take his life.

But it will never quell the character in his bones, lure the laughter from his heart, or still the spirit in his soul.

  

   

Nigel, MND and me. 8: Disco legs

The bag of death sits in the kitchen cupboard, waiting patiently for its moment.  It’s been there for quite some time and may very well be nudging its use by date.  Presumably, a new assortment of injectable drugs designed to relieve end-of-life torment would be prescribed, should Nigel happen to survive beyond the stated date. 

‘It’s a good idea to have them in the house,’ says the Hospice nurse, ‘so you’re ready.  Especially as there's a bank holiday coming up.’

Will he not make it past Monday?

This is just one of the recommended boy-scout, be prepared, strategies that we have adopted to ensure that Nigel’s ultimate demise is as he would wish.

Others include the Do not Resuscitate directive and Advanced Care Plan declaring that Nigel will not receive treatment or medication merely for the purpose of prolonging life.  He does not want to be taken to hospital, nor does he wish to be revived.  These instructions, folded inside a white plastic container sporting a green cross, are housed, weirdly, in the fridge.   Everybody’s got a fridge apparently and, therefore, attending medical professionals would know where to look.  As ours is an integrated appliance merging seamlessly with all the other gorgeous new cupboards I am supposed to mark its identity by sticking a green cross on the outside of it.  To hell with that.  There are limits.

Thankfully, not every be-prepared strategy is about Nigel’s departure from this world.  One, at least, has the sole intention of enabling him to remain in it a tad longer. 

The fitting of a gastrostomy tube is a relatively simple, but ghastly procedure, and one, we learn, best undertaken whilst the person is still strong enough to endure it.  In anticipation of Nigel losing the ability to swallow, and not wishing to suffer the agony of death by starvation, the operation has been performed, and Nigel now shows off this floppy protrusion from his stomach like you would a tattoo.

There is also the small matter of preparing our home for Nigel’s increasing disability.

At one time regarded as merely the place to which we return after work and play, it is now where we spend almost all of our long and largely uneventful days.

‘Wait ‘til I’m dead,’ Nigel says, when I nag that we should redecorate the lounge. 

Not a chance.   We should make our home as beautiful and as comfortable as we can whilst we’re living, I argue.

The battle is won.  The lounge has had a complete makeover.  The TV, once a silent anathema in the corner watched only on a Sunday (not because we were observing some peculiar religious practice - Sunday used to be the only night we were actually in), is now a friend, that even gets to air day-time programmes such as ‘Homes under the Hammer!’  It has truly earned its place on the wall within its exquisite setting.

Obviously the specially adapted bathroom is a must, but shouldn’t we also consider the longed-for, begged-for-for years brand new dream kitchen while we’re at it?

Well why not?

Won that battle too.

It is amazing how utterly absorbing the choosing of a kitchen sink can be.  Not to mention the frenetic consideration required regarding the tap that adorns it, the island within which it sits, the design, style and arrangement of the cupboards surrounding it and ultimately the walls - ideally awash with an arresting hue – all uniting in their depiction of a unique and complementary creation, wherein all manner of culinary delights are cooked up.

Add to this the problematic picking of ultra-posh porcelain to enable a fully equipped disabled wet-room and a ludicrously indulgent bathroom to be housed in the rapidly progressing extension that awaits, with high expectation, the outcome of my decisions, and you would be forgiven for assuming that the woman buried beneath a bundle of bathroom and kitchen magazines, has finally lost the plot.

So how is it that, despite months of agonising deliberation, now that the kitchen sink is fitted and working, I don’t actually like it?

Ah well.   Maybe it’s a girl thing.

Or perhaps, this preoccupation with all things inconsequential is infinitely preferable to focusing on the unrelenting weakening of Nigel’s limbs.

Fasciculations, or muscle twitches, are a common symptom of MND.  There is not an instant when Nigel is free of this. 

At its best, Nigel’s impression is of a kaleidoscope of butterflies trapped beneath his skin.  When I place my hand on the area I can feel the gentle fluttering but can’t see it.  Sometimes the legs are affected, sometimes the shoulders, chest, back or arms.   Often he can feel it in his face and neck, and even his tongue.

At its worst, this manifestation is profoundly disturbing, both physically and emotionally.   Nigel’s skin becomes the mesh restraining a nest of serpents swirling riotously in an alien sea.  The raging ripples are visible and merciless – almost mocking in their intensity.

‘Look at us,’ they seem to say, ‘we’re coming to get you.  These legs won’t work much longer mate.’

The crashing waves surrender to cramps – and with them comes the pain.  Nigel’s legs can spasm in painful convulsions for up to an hour.  There is little anyone can do.   If he wants to be held, I hold him.  If he needs space, I stand back, watching helplessly, unable to do anything to stop it.

‘You’ve got your disco legs on again, Dad’ says Becky, shining a welcome ray of light into the darkness.

A wry, but grateful smile is her reward.

But there will be no more discos for Nigel.

Nigel has always been the robust, physical type, accustomed to being in control.   Born in an era still regarded as the domain of men, Nigel clambered and clattered his way through childhood combining cheek with an equal amount of charm.  His good looks, confidence and remarkable maturity swept him smartly through adolescence - not for him the acne-ridden, gormless and gangly youth.  He was popular and sociable - a good mate.   He never had cause to be a bully, but was certainly drawn to be a battler – experience that came in handy those years in the Army, when his inherent courage served him well.   With the exception of a bullet and possibly the Police, Nigel has never run away from anything in his life.

Whilst definitely not professing to represent the alpha male, he is entirely comfortable when immersed in typically male pursuits.  Playing and watching rugby; enjoying a round of golf prior to a couple of hours in the 19^th; downing a few pints in the pub and happily undertaking years of back-breaking graft to carve a successful career in the construction game – all sit well with him.  He is made that way.   Of course, he has a softer, romantic, loving side, but fundamentally, Nigel is a big, bold, brash bloke.

As Nigel’s body fails him, an ominous vulnerability is emerging. 

The odd stumble and a distinct difference in strength, or rather, lack of strength, in Nigel’s left leg is addressed, for a little while, with the aid of a stick.   Being a stylish fellow, his elegant canes are soon a talking point at the pub.  Of the snake, crown and golf club heads sitting proudly atop the polished canes, the crown seems the favourite.  Lending, as you might expect, a touch of majesty.

Sadly, his fine collection of walking sticks is now consigned to the stand in the porch and Nigel has no choice but to accept the aid of a walker.   It helps for a time.  Until …

I hear the slow drag of Nigel’s feet as he battles his way along the corridor.   He steers the walker in sharp, faltering jerks.   Each ragged breath a painful rasp, each sluggish step a struggle.   His arms tremble as he grips the handles.   His shoulders shudder with the strain.  The lounge seems such a long way off.  He’s not going to make it.  He’ll fall.  His customary self-assurance dwindles as he fights with every quivering nerve and sinew in his treacherous body to haul one foot in front of the other.

It’s time for a wheelchair.

The alarming fragility that now engulfs Nigel is provoking within him spells of severe anxiety and sensations of panic that are completely foreign to him. 

The intuitive ‘fight or flight’ response to peril has never been far from Nigel’s consciousness.  Throughout his life he has had an acute awareness of potential threat.   It's in his nature.  In the face of danger, he has been able to make the life-saving decision to fight or to flee.

Now, he can do neither.