Friday, 7 March 2014

Decisions and Priorities.

For the last week my mind has been mulling over a situation that is causing me a lot of angst.  For those that do not know, my mother took her own life a year last February.  She had been struggling with her mental health since the death of my sister 4 years prior to her death.  She then lost her soul mate, my dad just over a year prior to her death.  This caused a critical psychotic episode which meant she had to be hospitalised.  As she was staying with me 200 miles from 'home' when this happened she was hospitalised near me to.  After three months she was well enough for discharge and she was encouraged by the hospital staff to stay in the area so that she could have continuity of service.

The mum that was discharged was quite different from the one that had gone in.  For the first time in a long time she was talking about her very troubled, abused and traumatic life as a war baby in post war Germany. This life continued right up until she met and married  my dad at the age of 18.  She was treating herself to new clothes (and bought me things when it was not a special occasion - this never used to happen).  She was going swimming with me regularly and often persuaded me to get on and go even when I was low.  She went away on holiday with a friend.  She was making plans of things she wanted to do.  She rented a bungalow with an overgrown garden and was in her element sorting it out and making a vegetable plot.  This state remained for about 7 or 8 months.

She had booked to go away again in the October/November (with the same friend to the same place), she had hoped this would help her over the horrid first anniversary of my dad dying and the anniversary of my sister's passing.  By the time she went I had already noticed she was not so good.  She was far more anxious about what she would wear and couldn't make decisions about buying new things for the holiday.  She then had the trauma of discovering when she got back that her landlord had put the bungalow on the market without even telling her.

Within weeks of returning she told me that she wanted to die and was struggling to stay alive.  Having not heard her talk about the community mental health team that had been looking after her and knowing that her Community Psychiatric Nurse (cpn) had moved on, the only course of action I could think of was to contact the GP.  They were great, they saw her straight away and were horrified at the state of her and the fact that she appeared to have fallen through the net with the community service.  By this time she was asking to be readmitted to hospital.  It is only now with hindsight that I can see how big a deal this was.  Her time in hospital had not been a 'good' experience, she had not been happy to be there.  Therefore asking to be admitted was probably a very difficult decision for her to have made.  The GP got onto the community team and arranged for someone to come out that afternoon (it was Friday).  I made sure I stayed with her all the time.

When the CPN ( one I had never met or had any contact with) arrived, she informed me that she had taken over mums care and I should have contacted them not the GP.  However when I informed her that I had no idea that they were still involved as no-one had contacted me since the old cpn told me he was leaving, she was at least apologetic that she had not been in touch with me.  She then proceeded to tell my mum that she could not be admitted back to hospital, the unit she had been in was now a dementia unit and there were no beds.  A discussion had been had before she came out to visit with the community psychiatrist and her medication had been increased.  Medication was one area that I had refused to get involved with - I have enough trouble controlling my own!

By December there had been no improvement, if anything she was slowly going more and more into a depressive stupor.  She had almost stopped going swimming with me.  I was having to go and fetch her to come round for tea, whereas before she had happily walked around.  I had found her somewhere to live - a lovely place just around the corner from my home.  She was anxious about buying it, but was doing the purchase herself along with the estate agent and solicitor.  I had to ask my brother to invite mum to his for Christmas to give me a break as now my caring role was becoming a daily activity.  He was very shocked to see how downhill she had gone.

At the end of January she had a review with her CPN, I had spoken to the cpn before the meeting to inform her that mum wasn't washing and was spending most of her time in bed.  During the review, mum was very quiet but voiced her anxiety about the move and life in general.

Then February arrived, a date for completion on the property was made, everything was set for exchange.  Then out of the blue I could not get hold of her.  After eventually having to break into her property I found her conscious but unresponsive and a pile of medication packaging next to her.  After being blue lighted to the hospital it took about 6 hours before I was finally informed that she was not going survive.  I was told it could take several days for her to die, thankfully she only lasted until the following lunch time.

Because of the nature of her death we have had to have a coroners inquest.  The coroners clerk regularly called and updated me on the process of the inquest as reports came in (or didn't in the case of the community services).  I was then given a date in December to attend and all the reports they had received were sent to me to read before the court appearance.  However I noticed that there was still no report from the community mental health services.  I said this to the coroners clerk when we arrived, he then went and discussed this with the coroner.  It was then decided by the coroner that the case should be adjourned as it was vital for a full report from the community team to be there as they were the only ones with regular contact with mum.

Last week I finally had another letter from the coroners office to say a new date had been set for next week and they also attached a report from the mental health team.  This was no ordinary report, it was a critical incident report which they had, had to complete for the health trust.  It was dated MARCH 2013, just a month after mum had died.  So I am left wondering WHY?????, why wasn't I informed that the report had been done, why had they not sent the report back when information was first requested from them by the coroner.  Why was so much of the information contradictory and in some places wrong.  Why was the appendix that should have been attached with a time line on it of their interventions with mum missing.  Why was there not mention of the change in CPN.  To say I was furious does not give justice to how I immediately felt.  Grief and anger came clashing into mind.  One week on, thankfully I am becoming calmer about it all.

So now, what do I do?  I decided to try and get hold of the person that wrote the report or one of the people on the management team that were named on the report.  A call was made 5 days ago, I was told I would be called back and that still has not happened.

How much time do I invest in this?  I am concerned that I am going to get to the inquest hearing next week and get too emotional to voice any of the above whys to the coroner.  Will he be interested anyway?  Trying to discern the right course of action to take has been exhausting.  Fortunately I have been able to talk through with my counsellor this process and she has helped me to look at how it is all affecting me.

Nothing I can do can bring my mum back.  However if I do nothing about these concerns and I keep them to myself, it is going to feel like I'm keeping some sort of secret inside of me.  This secret will never go away, I might find I can box it up and put it on a shelf in my memory, but it will never go away and as my mums experience has shown me, sometimes those secrets can manifest decades later when the mind comes under pressure.

So I have written this all down.  That is my starting point.  Next I need to sit down with the horrid report and mark clearly the bits of it that are wrong or that I do not understand (contradictions).  I am then planning to email the coroners clerk on monday with all my questions, so that I am not able to voice them during the inquest they can still be brought up.  I think I have also made peace with myself that if the coroner decides that no further action is warranted, I have to accept this.  However if this is the case I can still write to the health trust and let them know how viewing that report almost a year after it was written caused me too much upset.  I can also let them know my concerns about the details of the report.

If on the other hand the coroner thinks it needs further investigation, I can leave this to him to do.  It is not something I can do.  I may have quite a strong moral and ethical stance on injustice, but I do need to look after myself as well.  I still have a young family to look after, I still have a niece in an adolescent mental health unit, for whom I considered next of kin even though she is under the care of social services.  I need someone else to fight this battle for me if indeed it needs fighting.  Hopefully I can start to let go of all this unrest inside of me.  I am very much hoping that by this time next week I will be at peace with all the decisions that have been made.