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The Tolling Bells

The Tolling Bells

A lifelong dependence on prescription medication transformed Claire McCall’s father from a charismatic salesman to an anxious addict. She recounts the journey of his life and his final decline, and the devastation dementia can bring to families.

The Tolling Bells

My father was “the Man from the Pru” – or at least that’s what it said on his business cards. In 1960s Johannesburg, South Africa, he found it to be an agreeable pastime.

He’d be woken by the maid at 9am, a pot of Joko tea and the fizz of two Disprin on the tea tray. This set in motion a habitual practice – bath, a full English fry-up, and a flick through the Rand Daily Mail. Then he’d head out the back door, briefcase in hand, service in his stride. My mother, out to work long before the maid arrived, was chagrined. “Nobody wants to talk insurance first thing in the morning,” argued Dad. And he was right.

Having shown his face at the Prudential Insurance Company, his responsibility ended until evening – when he made house calls on fellow ‘10-Pound Poms’ to sign them up for an endowment. Fortuitously, this left a chunk of the day free, which was when he tore off his suited disguise and took with gusto to his ‘real’ job.

To anyone who mattered, Dad called himself a professional gambler. But he was disciplined: the ‘gee-gees’ alone were his game. He studied the form and bet only on horses that met his criteria. And he didn’t do too badly either. On Saturday evenings, he would return from the racecourse, toss a wad of 100-rand notes onto the carpet and instruct me, “Count that, will you?”

Dad was born in Carlisle in the north of England, the only son of a fabric mill worker. His mother had high hopes for him, so when he joined the service for three years instead of just the mandatory two, she was horrified. Dad served in Cyprus and Egypt during the Suez Crisis. A storeman in the RAF, he only fired his rifle once. One night on patrol, he saw what he thought was an Arab hit the deck. He shot. It turned out to be a paper bag.

At 185cm tall, with hands as big as paddles, he easily made goalkeeper on the soccer team that later returned home as RAF Egyptian Football Association Junior Cup winners, 1955. A decade later, that football medal sat proudly in his luggage as he left northern England to fly to South Africa and forge a life with his new bride.

Sadly, the Jo’burg sidewalks weren’t actually paved in gold but, in time, my parents built a lifestyle that made Dad feel like royalty. When our back garden was transformed with a pool, fountain and rockery, he’d recline beside the waters in a safari suit – master of his domain. His natural salesmanship and ability to pick winners on the track had earned him wall-to-wall sunshine. He had it made. Until he didn’t.

Not many years after he arrived in South Africa, Dad suffered a panic attack and collapsed on the parquet floor of our park-side home. His doctor prescribed the benzodiazepine Ativan to soothe his nerves. This can, over long periods of time, cause memory loss, depression and suicidal thoughts. The panic attacks and anxiety subsided … until Dad was asked to do something as simple as change a lightbulb. Then, panic rose as he held the bulb in his fumbling fingers, the glass breaking in his hand. Ativan is a habit-forming drug. Dad took it for 38 years.

In the 1980s, the whisky bottle became his ally. At 9pm, the ritual began – five Bells before bedtime. Then, in the 1990s, he was diagnosed with obsessive compulsive disorder (OCD). In a daily diary, he’d note how many times he’d woken in the night, his weight, the number of cigarettes and alcoholic drinks consumed, even the number of bowel movements. The silver lining was that his OCD kept his addictions in check. Self-imposed decrees stated that the first smoke of the day was enjoyed at 9am, and hourly thereafter. No drinking before 9pm.

However, in time, his list of can’t- dos moved beyond lightbulbs. Living with a man addicted to lorazepam, and who was hapless if not entirely  helpless in the face of everyday tasks, became too much for Mum. As soon as I graduated high school, she filed for divorce and returned to the UK. Two decades later, Dad, too, felt the lure of his birthplace. He packed up his medal and headed back to Carlisle.

The same December day in 2015 when 36 centimetres of rain over 24 hours caused the Rivers Eden, Caldew and Petteril to rise catastrophically, I flew in from New Zealand to help Dad find a residential care home. He had been admitted to hospital after a fall, and was sending plaintive text messages: “Get me out of here”. This was a storm of significance. Schools closed. Rescue centres opened. Some 45,000 properties were without power. But my father was oblivious. He asked why the damn TV didn’t work. Three minutes later, when the remote refused to perform, he asked again.

Since returning to England, Dad had been diagnosed with a form of dementia. Doctors were horrified to learn he’d been taking Ativan for four decades. One night, having set off the fire alarms with his incessant smoking, my father made a decision. In the space of a week he stopped his medication, smoking and the drink. He only once pressed the big red panic button when experiencing the tremors, palpitations and confusion that giving up his addictions entailed.

Despite his mental shortcomings, he’d managed to live independently for four years. He kept lists to remember to shower and shave, and bought the paper so he’d know the day and date. But his dementia and OCD precluded him making new friends. He couldn’t converse on any meaningful level.

The first time my father ended up in hospital was after a fall. Ditto the second and third time. After an evaluation, where an occupational therapist watched him ‘walk’ and make a cup of tea, he was sent home. There he mostly lay in bed, lying to the social workers about having eaten. In my phone calls to him, he was drowsy or panicked. He’d lost the light switch. He’d forgotten how to use his mobile phone. When the ambulance was summoned after yet another fall, he had a raging urinary tract infection. His trousers fell as he stood up from the wheelchair to get into the vehicle.

On my first visit to the Cumberland Infirmary, Dad was propped up in bed in a room of his own. A pair of walking boots poked out from the covers – he was ready to hike right out of there. Over the following weeks, it grew obvious that living alone was no longer a viable option. I attended a “best interest” meeting as his advocate, and various health professionals debated how sick he really was. In reality the assessment was already out of date, as his health situation changed daily.

Dad never spoke of dying. A brain tumour claimed his mother when he was in his twenties, then cancer took his sister way too young. On both occasions he preferred to ignore the inevitable as, metaphorical fingers in his ears, he fled the scene. He feared death, until he lived the alternative.

He had long forgotten how to use his mind, and now his body followed suit. Though the physiotherapist said there was no reason why he couldn’t walk, he didn’t. Then he got dysphagia and could no longer swallow. Official offerings moved to a pureed menu, and even liquids became a fluid foe. Giving him water was likely to cause aspiration pneumonia, which occurs when substances are breathed into the lungs rather than swallowed. When they taped a ‘nil by mouth’ sign by his bed, I asked if they could administer something to make him sleep through his hunger and thirst. I was informed that this was moving into the realm of palliative care. In hindsight, this would have been the easier path for both of us. But it was never offered.

With the phasing out of the Liverpool Care Pathway, there seemed to be no path at all. One minute I was discussing discharge options, the next I was told of the risks of resuscitation, and asked to make a decision. Amid it all, there were blood tests and urine samples. “Played for Carlisle United once, you know?” Dad would boast as he was wheeled off for another scan, his stick legs still planted in his hiking shoes. The nurses laughed: “He won’t take them off.” I could understand why.

One day, when he was pleading hunger, the nod was given for a carton of pureed mango. He gobbled it down. A minute later, the suction tube was down his throat as nurses stopped the food from choking him. I asked his young doctor, “Will he bounce back?” The answer was a definitive ‘No’.

On Christmas Day I arrived to visit, and for a heart-stopping second I couldn’t see him in the bed. He was slumped in a chair, a photo of his only grandchild – my son – dropped to the floor. When I went to give him a hug, he looked at me, his eyes intense. “Can I go to sleep?” I knew what he meant.

“Yes Dad. You can. You’ll be alright and so will I.”

“Thank you.”

“I love you, Dad.”

“I love you, too. Desperately.”

When I got to the hospital two days later, the nurse was concerned. Normally her patient was shouting the odds, but today all was quiet. Dad lay on his back as I willed him to wake.

I talked to him softly – a monologue about something and nothing – and stroked his hand. An hour later, I left him with the cricket commentary. It was the first test between England and South Africa; perhaps in his deep consciousness he might appreciate the rivalry. His coat was packed away, but his walking shoes remained on his feet.

When the call came, I wasn’t far away. The nurse, upset, said she had expected him to last longer. Would he have preferred a tot of whisky in his final hours? A snifter of Bells to acknowledge the tolling bell? I can’t be sure what that man in the bed would have chosen, but the Man from the Pru most certainly would.

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