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Today is father’s day. I’m spending today, and the week, with my Dad rather than my own kids because my mother desperately needs a break from being his full-time carer and he can’t be on his own. I’m useless at this, awful. In the same way as some people are uncomfortable around kids, I’m struggling with this. I can listen to my daughter ask me what my favourite colour is 15 times an hour and answer her with a smile every time, but I feel if my Dad asks me one more time what day it is, where I live now or where my sister is, I might snap. Maybe if I was around home more I might be better, but dealing with older adults with cognitive difficulty at close quarters is bloody hard.
Sometimes you read a journal article or blog written by a geriatrician about what words and terms you are and aren’t allowed to use and how you should communicate. They tend to write in a well-intentioned yet hectoring tone, with all the earnestness and angst of a quiet curate. I for one usually feel guilty after reading. I won’t anymore. What those guys do is hard. Rather than preaching at the rest of us for not being as good as them they should trumpet the skill of it. If they could then acknowledge that when a patient is in VT with blood pressure 40/20 and hosing blood out of their gastro-duodenal artery and you’re there with a yard of PVC, fibreoptic cable, a light bulb, a vial of adrenaline, and a few staples standing between them and the grave, perhaps they too might know what it feels like to be a bit inadequate at some aspects of the whole doctor gig, that’d be just super.
I’m sitting at the computer in the house I grew up in. There’s a faded old Santa photo from Cash’s department store in a pound shop frame on the desk. My Dad is the same age in it (36) as I am today and I am the same age in it as my boy is today (three). My boy looks just like me. Dad doesn’t look dramatically different then to how he does now. Maybe a little fuller around the chops back then. The guy dressed as Santa looks like he’s had a feed of Beamish. Dad is talking to me and I’m smiling back beatifically at him. It occurs to me that he probably got as much sense out of me then as I get out of him today, yet he looks patient, kind, and proud. By contrast when I looked in the mirror earlier I looked irritable, defeated, and ashamed. Frightened for his future and mine and for my own son’s. Thirty-three years passes quickly enough.
In another of our seemingly endless series of massive cock-ups we long since abandoned the philosophical debate about what we do to a load of ologists and virtue-signallers who have no clue of the nuance and complexity of the everyday practice of medicine. For that reason, paternalism, (from the Greek for father), is considered a dirty word and defined as “the policy or practice of restricting the freedom and responsibilities of those subordinate to or otherwise dependent on them in their supposed interest”. Quite how we allowed fatherhood to be debased in this way in our medical patois is remarkable. I look at him caring for me in these photos and paternalistically making sure I’m safe, secure, happy, and not wanting, and I wish more than anything in the world that I or somebody could do that for him now. He did it for me for years and now I’m failing utterly to do it for him.
The drugs don’t work. The people in the hospital try their utmost but are submerged in work. He strolls in once or twice a year, does an MMSE and strolls back out again to sit and wait in this half-life until such time as either my mother collapses or he becomes bad enough that we can’t mind him anymore, whichever comes first. They pat him on the back that things haven’t gotten worse and sure isn’t he doing great, while failing to notice the fact that he’s got “93-86-79-72-65. MICHAEL D HIGGINS. ENDA KENNY” carefully inscribed on the margins of the copy of the Examiner that he brings into the room under his arm. There’s too much cute Cork hoor left in him yet to fall for that one. There is nothing meaningful they can do for him or us within available resources. My Mum and the GP battle on as heroically as they can. Ireland has decided that this is okay. Until someone decides to change the name of Alzheimer’s dementia to ‘cognitive cancer’ or ‘smart attack’ it seems unlikely those resources will emerge. And therefore I will continue to fail him.
Happy Father’s Day.