Driving home last night with my daughter, Eminem was on Spotify.
The Real Slim Shady.
‘May I have your attention, please?
May I have your attention, please?
Will the real Slim Shady please stand up?
I repeat, will the real Slim Shady please stand up?
We’re gonna have a problem here?’
She said it reminded her of Spartacus.
Spartacus?
You know, Spartacus!
What do you mean?
Well, ‘Who is Spartacus?’
Oh, yes, the movie. I didn’t know you had watched it.
No, I haven’t, it was an episode of Outnumbered.
Who was Spartacus? She asks.
A gladiator then Roman Slave. He led a rebellion. (I don’t mention Kirk Douglas/Issur Danielovitch – a cultural reference too far).
Interesting.
My daughter gets many of her cultural references from TV.
Her favourites are Outnumbered (Hugh Dennis and co), The Office (USA), Big Bang Theory, The Gilmore Girls (According to Bonnie Tsui a favourite of Gulf War Veterans) and Friends.
This is generational.
Thanks to DVD then streaming, she has watched these programmes over and over.
I have spent hours in her company as Ross or Sheldon or Michael drone-on in the background.
None of this has much to do with today’s title.
Someone said this in a meeting.
I am unapologetically left of centre. On some matters more left than others. This seems to happen as you age and become part of the establishment with more invested in yourself than in society, with thoughts more focused on the practical, maybe it is a lifetime of six-am starts and too long days at the computer.
Nevertheless, I am always critical of the current government. Even when someone tries a justification. ‘Boris was great in his support of Ukraine’ kind of thing. No… One right doesn’t undo a hundred wrongs.
And so, it is with the health service.
I gather there is to be more money invested in the NHS following this week’s budget.
This money is a drop of urine in an Olympic Swimming Pool. It will soon disappear; the water will be safe by this evening.
It is demonstrable on virtually every measure that the Tories have done more harm to the country and NHS in their 12 years than any of Reece Moog’s wildest childhood fantasies.
I remember in 2008, as the markets were crashing, a conversation with a senior NHS leader, ‘Bad times are coming.’
She retired before it started to fall apart.
And there is more.
Are you all ready for this winter? For January and February, the darkest months?
When I think of reducing life-expectancy and A&E waits and that old woman who lay under a tarpaulin for 15 hours waiting for an ambulance (broken hip) and the cancelled operations and the outpatient waits – 12 months to see a doctor, two years for your operation and the nurses and doctors trying to balance five simultaneous tasks, given the post-Brexit workforce catastrophe and the cost of living crisis and the failing planet and our poisoned rivers and seas and the dispossessed youth and the homeless, you see where I am going.
And it sometimes happens during meetings, when I am analysing the situation and reflecting on root-causes that I suggest, either ironically, ‘This has nothing to do with the Tories,’ or more succinctly, ‘It’s the fault of Tory,’ that recently, at one meeting, the person chairing said, ‘I am a Tory.’
I didn’t have a response.
I was thinking, ‘Eh?’
Yes, I was embarrassed that I had brought-up the potentially taboo (my dad, a former Freemason would always tell me one of their rules, ‘Never talk about money, politics or sex’). Well, although I have never mentioned sex in a meeting, politics, is hard to avoid.
What do you tell the patient?
Yes, there is a 12 month wait for your appointment. Yes, there is a wait to join the waiting list. Yes, you might wait for the waiting list and not meet the criteria and find yourself off the list.
How do we explain what is happening?
It is possible I misheard my colleague.
Perhaps she said, ‘I hate the Tory’ which was mangled by Teams.
Perhaps, who knows.
Maybe she should take credit for her openness.
It is hard to find anyone airing their political allegiances around here.
In the US, people used to have bumper stickers proclaiming whether Republican or Democrat. I am not sure whether in the days of hire-purchase this still follows. In the UK this is not a common way of demonstrating your political leaning.
I only know one other public Tory. I haven’t asked her if she thinks differently now the cracks have become fault-lines. I daren’t.
And yet, there are millions out there.
Millions who perceive the world as a threat, who see the poor as a drain, immigrants, refugees, asylum seekers as lesser than less, there are multitudes who prefer to consider their own nest egg, who want more and more for those who have less and less.
The over-stuffed, the over-fed, the rich, the misled, the easily swayed.
No, I am not making new friends with this blog.
No apologies.
And, had she said, ‘I want the Albanians/Africans/Syrians out of here, Rwanda the sooner the better,’ would I have stayed silent? Yes, I was perhaps wrong with my political allusion when discussing the care of older people, and yet.
Argument in my experience doesn’t take you far. It is two opposing forces colliding, it tends to create more energy for resistance with greater fallout and destruction.
Years ago, I described the martial art of dementia. This makes me think of the scene at the start of Enter the Dragon, where Bruce Lee tricks the cocky South African into climbing into a rowing boat on the way to Han’s Island.
‘It is the art of fighting without fighting,’ he smiles.
It is not uncommon, when working with those who have dementia for your realities to collide.
‘Have you seen my mum?’ Asks 95-year Molly, ‘I need to find her, I saw her through the window.’
There are classically three responses.
You can say, ‘Molly, you are 95, your mum is dead, you have dementia, you live in a care home, sit down.’
That is one way, not the way to do it.
Or, you could say, ‘Molly, your mum is running late, she will be here shortly,’ this is a white lie or half-truth (she is running 50 years late) – no real harm although the principle of lying creates a precedent that is pernicious and detrimental to most relationships (In my experience).
Or you could use ‘diversion’
‘I haven’t seen your mum, would you like a cup of tea,’ or, ‘I am not sure where your mum is, where did you grow up?’
This is called diversion and distraction.
It is acknowledging the other and using your skills to manoeuvre in another direction. It almost always works (unless the person is in a state of heightened arousal – the trick here is to back-off and give time and space, or, if their dementia is too advanced for verbal communication, in which case, more subtle physical interaction might be required – using tone of voice, body language, smiling, eye contact, and so on).
With strategy 1, the ‘mum is dead’ the most common response is escalation, ‘My mum is dead?’ with more upset or, ‘My mum IS NOT DEAD!’ Leading to more anxiety, fear and escalation.
I don’t recall how I managed the ‘I am a Tory.’
I suspect I used diversion.
Maybe I should have replied, ‘I am Spartacus!’
Have a good weekend y’all (even the Tory).
I love every word as always. The drop of urine in the swimming pool made me laugh out loud. I had an interesting chat with a patient the other day. I’m normally good at sussing out their views before I get on my soap box. But this lady started with “I’m annoyed about the prime minister” so I prematurely jumped on my soap box and ranted for ten minutes about the tories not caring about the likes of you and me etc. She then followed up with “no, I meant I want Boris back!” So I had to resort to my skilful (if slightly naughty) questioning that always ties these people up in knots when they can’t actually provide any facts to back up their Daily Mail-fuelled ideas. By the time she left my company, she was quite bewildered, and almost speechless, apart from muttering a subdued “Thank you for your help”.
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Thank you Helen! I’ve not quite been there but come close! The Daily Mail lying by the armchair usually gives them away 😄 (harder in a clinic setting!!)
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