As Granny Pat’s final decline was quick and easy, Granny Nanna’s, Amanda’s maternal grandmother, was proving to be the opposite. The day after Granny Pat’s funeral, fighting our way through heavy traffic and a blinding hangover, we cut across countless northern towns and bypasses to Nottingham to visit Nanna in her care home.
Only a year before Nanna had been living in the post-war detached house in a working-class Salford suburb that she had moved into with her new husband Eric in 1947. She was a minuscule woman, no more than 4 foot 6, with thin ginger hair and stick-like limbs, who kept her house spick and span, though redolent of 70 years of accumulated Embassy cigarette smoke. On flying visits Amanda would cram her freezer with meals for one, and go and ask the neighbours to keep an eye on her. Nanna didn’t seem to have any friends of her own. Since Eric had died it had emerged how controlling a husband he had been. Long-withheld stories of his intransigence and meanness spilled out. She told Amanda she had married the wrong man.
‘Don’t marry the tinsel instead of the gold,’ she said. I feared she was referring to me. ‘Like I did.’
Nanna’s husband had worn her down to papery meekness. Even after he died she didn’t have the confidence to get out of the house and pursue new interests. She had a daughter, Amanda’s mum, but she had died of alcoholism 25 years ago, and it looked to me like – on top of everything else – the shame and pain of that had never fully faded. Mike and Amanda, her only grandchildren, had made new lives away from Salford. Nanna had only one reliable friend left: the TV. Well, that, and the cold-callers from the double-glazing, broadband and scamming industries, for whom she was easy pickings.
Amanda grew worried when Nanna, who had saved money all her life, said that a nice builder called Nicky Thomas was going to fix her gutters for only four thousand five hundred pounds. He had even given her a discount. The day Thomas drew up in his dilapidated and filthy van the neighbours kindly told him to bugger off before they called the Police. Nanna also got involved with negotiating quite a few complex telephone and TV packages but I think drove the salesmen so mad that they gave up on her before they could close a lucrative mis-sale. But she always sent Amanda £100 on her birthday and at Christmas, in a card which Amanda opened in a wave of guilt because she didn’t spend more time with her. It was another difficult consequence of her mum dying. The responsibility for caring had jumped a generation and Nanna really didn’t want to be a burden on a forty-year-old grandchild with her own twelve-year-old son.
Things started to get more worrying when Nanna said that the man in the television was telling her there was someone upstairs, and that she couldn’t fully explain who he was or what he was doing because the man in the television would be angry with her for talking to Amanda. Amanda got in touch with Social Services and we made the four-hour drive from Somerset to see Nanna with the team leader. Nanna was confused and on a loop about the man listening in, whose powers were increasing because he could now turn over the TV channel and make her watch things she didn’t want to see. Amanda ran through the controls on the handset for the twentieth time, but it was hopeless. Such things were beyond Nanna.
Already shrunken, she was now frighteningly emaciated, though her deep-socket eyes lit up as she gazed with adoration at the granddaughter she hardly ever saw. It was painful for Amanda to see how much she was missed. But Amanda couldn’t go and live in Salford. Her son Haruka was at school in Somerset and Amanda had a shop in Glastonbury. It was impossible. And Amanda couldn’t house Nanna with her down South. She had just moved into my house, and even if she hadn’t, she was out all day working in the shop and away three months a year manufacturing clothes in India and Nepal. She had to make do with phone conversations which had to be shouted and repeated because Nanna couldn’t get her hearing aid to work. Nanna told Amanda, how fed up she was.
‘I’ve lived my life Amanda, and you’ve got little Haruka. I don’t want to be any more trouble than I already am. But it’s the bloody man in the TV again. He’s not leaving me alone. He can talk to me from the loft. I’ve got to go up and check. Nicky Thomas telephoned. Did I tell you? He said he could probably help. But I’m that tired Amanda. I’m that bloody tired I don’t know if I want to go on, Amanda. Can you hear me? It’s that bloody man, he’s hearing what I’m saying. Did you hear what he said? Did I tell you he changes the channel on the telly? I’ve called them at Sky that many times and I’ve told Debbie – she’s ever so nice – but she said there weren’t nothing she could do as it didn’t fall under the warranty. Imagine that! There’s a man in me bloody TV and it’s not covered. Warranties, they never work when you need them.’
A week later we got a call from Rita, a neighbour, to tell us that Nanna had fallen down the stairs and been taken by ambulance to hospital, where she was in a highly confused state. When Amanda got back from seeing her, she was distraught. Nanna hadn’t recognised her. She didn’t know where she was or even quite who she was. She had wet her bed and lost her slippers.
Through tears, Amanda said, ‘When I finally got through to her she said “Amanda! Oh Amanda! Oh I’m so happy to see you. Thank you for coming. I’ve been so worried about you. Where is this place? Why am I here? I want to go home and die, Amanda, I don’t like this place”.’
Amanda tried to get her discharged, but the doctors weren’t having any of it. Amanda and her brother Mike explained quietly to them that Nanna wanted to go home and die. The doctors said they couldn’t let that happen. Exasperated, the best Amanda and Mike could get was a DO NOT RESUSCITATE order, and hope for pneumonia.
To me the decision to keep Nanna in hospital seemed inhumane and cruel, not to mention extravagant and crazy and lots of other things, all bad. Here is a small statistic for all taxpayers to consider: on average, 40 per cent of a person’s medical costs are spent in the last six months of their life. (This figure is disputed. Some think it’s too low, others too high. My advice is to do your own research.) All this money being wasted on Nanna, keeping her in torment against her will could have been spent on getting better treatment for a child with cancer. Nanna got a urinary infection, which was standard for geriatrics in hospital, and Amanda took her son out of school to drive up for what we thought would be their last goodbye. But when she got there, she found Nanna sitting up in bed. The doctors had prescribed antibiotics and she was responding well.
Two weeks later Nanna was deemed ready for discharge, but not back home, because the assessment by Salford Social Services was that her home, with no toilet on the ground floor, and Nanna unable to manage stairs, was not fit for her habitation. They were looking to supply a bed and a chemical commode for Nanna to use downstairs, and arrange for care workers to drop by to check she was OK twice a day. We knew that Nanna, already deeply confused and weak after her infection, would not be able to deal with this arrangement. The image of the poor old woman sitting on a plastic chemical toilet in the brown tinted hallway was unbearable. The idea of Nanna going home quietly to die was now looking horribly messy. It was one thing her being allowed to die there, but sending her back to a lonely demise with a chemical commode didn’t seem right. It crossed a line.
There followed a wrangle with the Council, basically over money. If Nanna was placed in a care home, the Council would only pay five weeks before Nanna would have to stump up the £2000.00 a month it cost. Nanna had worked for 60 years to pay off her mortgage and save £10,000. In five months a life’s worth of thrift would be wiped out, and soon after that her modest home – which she had longed to leave to her two grandchildren, to give them a foot on the property ladder – would be sold and bit by bit handed over to the government to whom she had paid all her taxes all her life in the belief they would look after her in her old age.
A few friends said there were some scams to get round the Council taking the money from Nanna’s house to pay for her care. It did seem iniquitous that those who hadn’t saved anything were getting the same care as those who had put something aside all their lives.
But Amanda and Mike accepted their fate: they were probably not going to get their deposits for a home of their own. They resigned themselves to losing it all, because the alternative seemed to be wishing Nanna would die for pecuniary rather than humane reasons. And they didn’t want to do that.
So Nanna was put into care in Salford, and her first words when Amanda and I went to visit were ‘Are you Lois?’ She had lost her false teeth and her hearing aid was broken.
‘No Nanna, I’m Amanda,’ Amanda said, kneeling by her chair and stroking her sparse hair. ‘It’s me. Amanda.’
She darted a look at me. ‘Who’s that horrible man?’ she snapped. ‘Standing there like that. It’s not Mike is it?’
‘No Nanna, that’s Guy.’
‘Who’s Guy? Get him out of here. I don’t like him.’
I left the room and looked around the place. It was a two-storey modern purpose-built building with wide fire doors and a dozen bedrooms off a day room where the patients sat, some with children or spouses struggling with anguished conversation.
A woman came in with a little cake and card. ‘Happy birthday darling,’ she said to a man, who looked at her blankly. ‘How old are you? Can you remember?’
I could see what was going on here. They were losing their minds, and one or two strikingly early. There was a man not much older than me being served tea by a nurse while doing a commentary on a cricket match in his head. I didn’t want to sit down for fear of being mistaken for a patient by another visitor, and given the kindly but anxious smile that I had been dishing out. I went back to Nanna’s room with its view of a roughly mown lawn, Larchlap fence and leylandii; Amanda cradled Nanna’s head in her lap stroking her hair in the most tender and loving way conceivable. Nanna’s eyes were closed, and her brittle body in repose.
‘I don’t know Amanda …’ Nanna was saying. ‘I don’t know whether I am living or dying. I don’t know. My hair’s a bloody mess. I’m a mess. I’ve gone to pot. I don’t know. I don’t bloody know any more.’
The drive to Salford was simply too much for Amanda and Mike to do every week, so it was decided that Nanna would move to a care home either in Somerset or Nottingham, where Mike lived with his young family. Characteristically, both siblings said they wanted her close by, and would therefore bear the brunt of the work, so we all started to look at care homes.
Here are a few facts I discovered reading Atul Gawande’s sobering Being Mortal, a book about ageing: In 1900 life expectancy was under 50. Today it is over 90 if you are a Korean woman, and not much less if you are a Brit. In the mid-1800s the average family size was 7. It is now just over 3. We all know parents and offspring used to live together in the family nest. Now just 10 per cent of Europeans over 80 live with their kids. This means there are a lot of wrinklies needing to be looked after by very few children, who don’t live anywhere near them. Hence the care-home industry. We are doing what social scientists call ‘intimacy at a distance’. Or at least you lot are. I called my mum about once a month and was plotting to kill her.