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A few months ago ‘Elizabeth is Missing’ was nominated to be our book to read in book club. It was completely new to all of us (including the member who presented it) which meant that we all went into the book blind, with nothing to go on but a handful of internet reviews and the knowledge that this novel was the author’s debut. That’s always a risk, but fortunately for me…. It turned out well.elizabeth-is-missing-emma-healey-620x350

Without spoiling the story for whoever may read it, the book is centred upon Maud, an elderly lady who is, throughout the book, progressing within the stages of Alzheimer’s. It is written from her point of view, as she embarks upon the quest to find her best friend Elizabeth who… believe it or not, is missing. This unusual ‘crime fiction’ is hindered, however, by the unfortunate problem that Maud can rarely remember a) that Elizabeth is missing and b) the enquiries she has already made. The investigation into this disappearance is intertwined with a flash back tale uncovering a greater story of sadness and pain from Maud’s childhood, which has been unresolved for so many years.

This book divided our group quite strongly, but for very specific reasons. Some found it very hard hitting, and too close to home for those who have had an intimate relationship with Alzheimer’s. Hearing the raw and frustrating feelings of a woman in the grasp of such a vicious disease was grating to the wounds of loved ones who had been taken by that same dignity stripping illness. Because of this, several members of the group could not read very far into the book before closing it, although many battled on through. Some were able to separate their own experiences from that of Maud, and enjoyed it for what it is. I, was a perpetual mix of a million and one feelings.

As a nurse, I have had an innumerable amount of encounters with Alzheimer’s sufferers in varying degrees of the disease. I’ve studied it, I’ve done case studies and I’ve strived to treat every dementia patient with as great a respect and understanding as possible. That said all that I’ve ever learned or observed has been from the point of view of healthcare professionals and family members. Never before have I had a true insight into the actual realities of being a dementia sufferer. Until now.

This book was so delicately and expertly written. For a debut novel it is truly phenomenal. The nature of dementia/Alzheimer’s is such a sensitive subject and one not to be explored lightly. It is also very prominent in society’s eye at the moment, and this book could not have arrived at a more perfect time. To be able to experience life through the eyes of someone with this illness is really amazing. From the frustration, and emotional trauma of not knowing who someone is, where you are, how you got there, and whether you’re safe or in trouble, to the irritation of not being able to recall simple words for simple objects. There is a point in the book where Maud is trying so hard to remember the word for pencil- she is racking her brain to uncover the word that just will not come. She explores many words that it could be called and she describes the elements of the object, before discarding the pencil and moving on. The interesting thing that struck both me, and in fact my mother also, was that she couldn’t remember the name- she couldn’t think what it was, and yet she uses the word ‘pencil’ when discarding it. This was as if her recall just would not compute, but naturally somewhere deep down she knew the word. It was that she couldn’t combine both areas of her brain to work together in the retrieval of this simple and yet at that moment, oh so complex, word. This could only have been portrayed by very clever writing and an astute knowledge of the working brain.

Relationships with anyone suffering with a form of dementia, is hard, and often very testing too. Emma Healey paints a brilliant and so real picture of the strain, guilt and aggravation that comes from looking after a relative with this disease. We spend the book watching as Maud’s daughter Helen battles with all of these feelings. At times, I found myself annoyed by her, and felt that she was much too hard on her poor old Mother, but then as the book progresses, you see that she is just frustrated and often feels so very guilty that she cannot keep her Mother safe and happy all the time. I definitely think that this was the beauty of the writing. It explores the snap judgements we make about other people when we see only a snippet of their lives and have no idea the strain that they are under. Everything that Helen feels and most of the way she behaves is actually highly natural when you stop and think about her day to day life dealing with her Mother’s differing memory and behaviour. So often when I have been nursing dementia patients, they would have a period of lucidity where they knew who I was, where they were, and everything in between. But then there are times when they would, very suddenly, become completely unsure of who I was, where they were and even who they were. And note that I’m not a close family member or friend. I’m an employed health professional, so everything I would feel in those situations would be very little in comparison to a daughter, a sister, a friend- anyone with deep roots in the relationship. Those times were distressing for the patient, and actually even for me. Moments like this, are helpless. There’s nothing you can do to alleviate the stress except sit with them, hold their hand and assure them that they’re ok. Maud’s granddaughter Katy is a brilliant example of this. In these moments, she does nothing more than love her, sit with her, and be normal with her.

Although it is the title of the book, Elizabeth’s disappearance is not the integral mystery to the tale but is merely a trigger for the greater story. I won’t tell you much about this area of the book, since I am hoping that you will read it for yourself, but what I will say is this…

The feature of a flashback to Maud’s childhood, where one traumatic event shapes the rest of her life, and more importantly to the tale, shapes the angst of Elizabeth’s disappearance for Maud, is very poignant. One thing that I notice regularly with dementia patients is their incredible memory of past events. Often, if I were to ask what they’d had for breakfast, they wouldn’t be able to tell me. (Although to be fair, my memory of earlier in the day is regularly the same!) But if I were to ask what happened 50 years ago, that is another matter entirely! The development of the story from her childhood is a brilliant addition to the book, for without it, it would be a very short and relatively depressing bunch of pages. The flashback and subsequent conclusion captivated me and spurred me on to the end. Many people in my book club were disappointed with the conclusion. I, was not.

If you are looking for a fast paced action book with guns and constant adrenaline, you won’t find that here. What you will find, however, is a very eloquent and intimate depiction of the reality we are faced with in a world ever increasing in the number of people living with dementia. You will enter into a life seen through the eyes of an elderly lady slipping into the grips of Alzheimer’s, and the pull that it has upon her life, and the lives of those closest to her. This book is beautifully written, with times of laughter, sadness, and all the other emotions you can find wrapped into one. It’s delicate, and it’s thought provoking, and ultimately it’s just a wonderful read.

I truly think that if you are in any area of healthcare, this is a novel that you should read. It has made me check myself, be mindful, and really has changed my view of dementia for the better. This is an insight that is incredibly important to have. There are some illnesses in life that you can fully sympathise with, and even empathise, but there are also some that with all the sympathy in the world, you will never know what it’s like unless you’ve been through it. This disease is the latter. But as Nurses, Doctors, and really just as human beings, it’s important to strive to, where we can, really understand the workings of those around us, so that we can reach them, look after them, and give them the respect they truly deserve. This book highlights that very well to me, and I am thankful to Emma Healey for sharing it with the world!

Elizabeth is Missing

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The night before my first day of work, I was rather upset and terribly worried about what was to come and the prospect of being a nurse for-EVER. Sitting on my bed, crying, what can only be described as a river of tears; my wise mother told me a story which I would like to share with you today.

(I cannot promise that I will tell it as well as she did on this particular night, but  I will endeavour to do it the justice that it deserves.)

There once was a beach, a rather vast expanse of a beach. One day there was a terrible accident and the starfish of the sea were mercilessly washed up on to the yellow sand that covered the area. Hundred of little pink starfish were stranded on the beach with no way of being saved. A young boy, who was walking along the sand that day, spotted the victims from afar. He looked at them, and without a split second of a thought, he began to pick them up one by one. Running to the water side, he threw them gently into the sea, giving each one back their life. The little boy’s father came to join him, and as he looked at the task his son had begun, he stopped the boy in his tracks. ‘Son’ he said, ‘what are you doing?’ The boy looked at his father and said ‘I’m putting the starfish back.’ ‘But Son, look how many there are, you will never be able to put them all back, you will never be able to make a big difference, there are just too many to save. Why are you bothering? You could work all day, but it won’t make a difference.’ As he held a soft pink fish up to his father’s eye-line, the boy replied ‘It makes a difference to him.’

The wisdom that my mother brought to me that night was this: though it seems like you are not even close to making a difference to anyone’s life on the big scale, you’re making a difference to that one single ‘starfish’.

In the last three weeks I have persisted in an overwhelming struggle to adapt to the pressures that the modern health service has for me. Since beginning my new job I have faced a variety of challenges both emotionally and physically. If I’m honest, I have questioned at many points whether Nursing really is the job for me. My passion is person-centred, holistic care. It feels as if this is something that is un-obtainable and un-achievable within the hospital setting, and with more relevance, within the ward that I work on. Many people have declared that it is possible to give person-centred, holistic care if you ‘just make the time’, but I question whether these people have truly worked within the pressure of emergency care. It is almost impossible to even talk to a patient for longer than to ask a question, already it has become a never-ending battle with being pushed from one task to another, the persistent drive for discharges is overwhelming. I am constantly frustrated with the lack of opportunity to give my full attention to the patients and to look after not only the physical needs of those I care for, but their emotional and spiritual well being, too. This irritation makes me question my career choice even more. However, I have clung on to the wisdom of my mother, striving to visualise the lonely starfish of my ward and although I may come home at night thinking that it’s too big a task to make any real difference, I live in hope that I may have saved just one person’s physical, emotional or spiritual life.

Last Sunday I had decided that I would not be going to Church. My plan was to sleep until I woke up and then relax in front of the TV for the rest of the day. God had other plans. I woke at 10:30 with time enough to get ready for church. I arrived after deciding that I would just stay for worship… In the worship time I really felt God remind me that struggles and suffering is sometimes a good thing but that he is standing right beside me through it. This was such a relief.

‘…we rejoice in our sufferings, knowing that suffering produces endurance…’ (Romans 5:3)

 I stayed to hear the preach and was blessed so well by Hugh Pearce speaking about ‘rest’. It was a perfect reminder that the ‘rest’ that the world offers does not revive and refresh, but Jesus alone brings true ‘rest’. This was a much needed message to hear. (There was a lot more to it than that… If you have some time I’d very much recommend it. You can find it HERE.) Man, does God speak when you least expect it. I’m very blessed to have a wonderful counsellor in my life who cares about MY holistic care and I just hope and pray that I can take Him with me to the starfish of Kent.

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This is how I would look, if I were in fact... A sheep.

I recently qualified as a Nurse… And I guess the only natural progression is to then get a job and start to work! Well yes, I am a sheep. I have stepped into the conventional progression of life as outlined by society. As I blogged a while ago, I had an interview and was successful. I have been offered a full time position on the ward that I have wanted! (Or let’s be honest, the ward that I had said ‘If I have to do it, then I want to do it there!’) The annoying thing is… However much I’ve wanted to quit nursing because I’m tired, and worn down (and the politics on the ward are taxing…), God seems to have had different plans for me than I had for myself. All along the way of interviewing and getting a job, I’ve been a bit naughty and tried to outwit the Lord of the Universe. ‘If I don’t get a job through this interview, well then I’ll just take some time out.’ ‘If I don’t pass this exam, then I’ll book a ticket to America and not come back for a year’. Yes… it hasn’t worked. I’m pretty sure God has sat on his throne and laughed at my stupidity throughout this time.

And so, with a job looming, for the past few weeks I have been battling with a gradual progression into the depth of a nervous breakdown. The thought of stepping into the big bad world has engrossed me in absolute fear. Not just the usual big bad world of work, but the big bad NHS! The idea of becoming a real life Nurse with real life responsibility and life and death situations and decisions, in my very incapable hands, is just entirely ridiculous. My fear was/is such that I had even put off phoning the ward to confirm my start date. However, I faced my fear; I picked up the phone and then made a trip to the hospital where I proceeded to retrieve my new uniform. This added to my absolute petrifaction and pushed me ever so slightly closer to that nervous breakdown that I’ve been stepping towards… As I pulled the light blue striped and pleated dress over my head and wiggled the zip up, I turned and looked in the mirror. At that moment, I knew that there was no going back (also in that moment, I thought I was going to hyperventilate… But that’s a less poetic part of the story!). It’s interesting that fear can become so overwhelming… sometimes even to the point of losing sleep, loss of appetite and a crazy fluttery tummy!

Apart from allowing you to clearly laugh at my idiocy, I wanted to share with you something that God has taught me in the last few weeks…

  • Even though life is sometimes hard and scary… you’re safe in God’s hands.

Yes. That’s right. It sounds corny and ever so slightly clichéd, but I’m not taking it back because it’s TRUE.

There are a lot of examples in the bible where people have struggled in situations and are scared but God comes through for them in the nick of time! (Kind of like Superman… But real!) Well, we’re told that the God of the bible is the God of now… So that to me, suggests that he comes through for us here in the 21st century, too!

This Monday just passed, I had a meeting at my new ward to sort out some paperwork… The night before, I prayed myself to sleep, asking God to give me peace about it. I had the best night’s sleep I’ve had in a long time! This was such a blessing to me and a clear example of God’s grace! It’s funny what a simple thing like ‘the feeling of peace’ can do!

Throughout the week, I have been reminded time and time again of the safety of being in God’s arms, the beauty of taking refuge in Him and the absolute gift that it is to rest in the Father’s presence. I indulged in some Psalms this week, and my heart was engrossed by psalm 57. It says this:

 1 Be merciful to me, O God, be merciful to me,
   for in you my soul takes refuge;
in the shadow of your wings I will take refuge,
   till the storms of destruction pass by.
2I cry out to God Most High,
   to God who fulfills his purpose for me.
3 He will send from heaven and save me;
   he will put to shamehim who tramples on me. 

 God will send out his steadfast love and his faithfulness!

 4My soul is in the midst of lions;
   I lie down amid fiery beasts—
the children of man, whose teeth are spears and arrows,
   whose tongues are sharp swords.

 5 Be exalted, O God, above the heavens!
   Let your glory be over all the earth!

 6They set a net for my steps;
   my soul was bowed down.
They dug a pit in my way,
   but they have fallen into it themselves. 

7 My heart issteadfast, O God,
   my heart is steadfast!
I will sing and make melody!
 8 Awake, my glory!
Awake, O harp and lyre!
   I will awake the dawn!
9I will give thanks to you, O Lord, among the peoples;
   I will sing praises to you among the nations.
10For your steadfast love is great to the heavens,
   your faithfulness to the clouds.

 11 Be exalted, O God, above the heavens!
   Let your glory be over all the earth!

It would take an age to truly unpack the brilliance of this Psalm, but simply, this brings to me a realisation of the importance of taking refuge in God, resting in ‘the shadow of His wings’, but more than that: praising him in the storms of life, exulting him high above the heavens and the earth, proclaiming his worth and his greatness in every season of life.

When praying about this very thing, yesterday, the song ‘strength will rise as you wait upon the Lord’ started playing. At that exact moment, that was just what I needed to hear and remember. I am constantly surprised by God and his steadfast, faithful love. How good it is to know that we’re not worshiping an inanimate object, but a living God who listens, and responds. I am so thankful that I have Him, who clearly knows what He’s doing, on my side.

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“Before I formed you in the womb I knew you, and before you were born I consecrated you…”     (Jeremiah 1:5)

A phrase I hear often and yet have never really spent the time deliberating is ‘the miracle of birth’. With a fast growing number of pregnancies and babies around me, at times it can become rather monotonous. Having recently undertaken a four week midwifery placement, I have been drawn to consider the weight of that statement; ‘The MIRACLE of birth’. I’ll be honest, there is a great deal of blood sweat and tears involved in the process (and obviously I mean that quite literally) pain being very high on the list of what is involved in this so-called ‘miracle’, and yet… Women, proceed to endure this on a daily basis and not just once, but several times. I have experienced in those 4 weeks, almost every type of birth a woman could have and every single one of them have involved varying degrees of pain (Eve did not do her sisters any favours in the garden of Eden since this pain is yet another consequence of the fall…). So, why do we put ourselves through it, and why is THIS described as a miracle?

The human body amazes me, it really does. The intricacy of design is just perfect. Every so often I find myself a little overwhelmed by its perfection; my brain struggles to comprehend it. Pregnancy and childbirth falls into that category. A human being is grown, and its life is sustained from inside a woman. Going back a little further to the creation of that human, in very simple terms, an egg- teeny tiny egg, meets a sperm- a little tad-pole like thing,  they connect, they embed themselves in the wall of bit of muscle, and there is the beginning (the blueprint, if you like) of your human. 9 months later, the development process is complete and the woman begins to endure possibly the worst pain of her life with the one intention of pushing that baby out of her body and into a very different world than that human is used to.  There is a very complex process involved in labour that the body (in most cases) just seems to know what to do, naturally. Even if you haven’t yet been through childbirth, you’ll know what to do when you get there, because it’s natural, and your body coaches you though it (with a little help from the midwife…). A phrase I heard often in my 4 weeks of midwifery is ‘I can’t do it…’, but you can, because you have to and because your body is designed for it…!

I admit that at times I become rather blasé about the human body and more specifically about childbirth and babies since it and they are around me as a regular feature of my life. And yet, when I sit and think about it, the weight of that statement ‘the miracle of birth’ completely strikes me. God’s grace and love to us that he has given us such a gift, is shown very clearly through this. I know that the majority of my female friends, if asked, would say that they would love to get married and have children. Some even would go as far as to say that this is their ultimate life’s goal, their desire and their chosen ‘career’. It seems to be embedded into a woman’s heart to eagerly desire this. Why? Because it’s a beautiful gift and it is God’s design. I am no theologian, unlike my brother, I don’t gulp up commentaries and study the crazy clever texts that delve into the deep mysteries of biblical history. I wish I did, I wish I cared, but I don’t. All I can do is speak from what I see, the experiences I have, and see God in my daily life. I find that although Nursing is a massive slog for me, it is a place when I can regularly see God’s majestic hand on a broken world. Something that amazes me is his unconditional love for the people of this earth.

“Before I formed you in the womb I knew you, and before you were born I consecrated you…” (Jeremiah 1:5).The God of this universe knew and loved each and every one of us before we were even born, before HE formed us in the womb. We are a creation of God. He formed us. He put us there, in our mothers’ bellies. He knew us before we were born. He declared us sacred. He smiled down upon us as he made us living. That is the miracle. The fact that every living person on this earth was made alive by God astounds me. That he chose for me to be born. That he chose the person who lives 5 doors up from me, to be born. That he chose someone who lives 900 miles away, to be born. It astounds me. No one is a mistake. He has a plan for every single one of the people that he formed. That is the miracle.

‘The MIRACLE of birth’: It sure it that.

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Religion and healthcare has been, from the beginning of my Nursing degree, and still continues to be, a great passion of mine. Whether I contemplate the impact that my own religious beliefs have on my life, or if looking to my patients and their ‘holistic care’, I am strong in wanting the most for spiritual care. But I have recently been drawn to consider religion and the workplace.

Two weeks ago I had my first proper interview for a Nursing post in a large general hospital, I was asked at the conclusion of my interview if I had any questions to ask my interviewers. I only had one. I am currently on a 4 week elective placement. When I was given my shifts for the first two weeks, I was disappointed to see that I was due to be working for both Sundays. I had a lengthy discussion with my previous mentor about the consideration of working hours when being interviewed for a nursing post and we together were curious if that was something that was asked and taken into consideration by the NHS. My question was simple and was by no means an opportunity to ease my curiosity, but was practically for my own knowledge. I posed the question to my interviewers ‘Does the hospital have a policy for Sunday working in relation to religious persuasion?’

I was faced with two rather blank looks. This seemed to be a question that had not arisen before. Apparently no-one else was worried about working on the Lord’s day…

I remember a time when Sunday was actually acknowledged in England as different… Shops were open, but only for a limited time and NO-ONE was forced to work on a Sunday if they didn’t want to. In fact, no-one would even be put on a rota for a Sunday unless they had consented to it.

The answer that I received came with a hint of disgust ‘We do run a 24 hour, 7 day a week service you know. There are patients to treat every day of the week, even on Sundays, at Christmas, Easter and other important days to you… I believe Churches have a morning and an evening mass, surely if you were to discuss it with your ward manager then you could work out a way to go to one or the other, but you’ll have to be flexible…’ It became very apparent to me that times have changed. Although I am well aware that healthcare stops for no-one, and I am more than happy to work the occasional Sunday… I also am very aware that for me, God comes first, Church comes first, yes… even above my job and the money that comes with that…

Now that we have come to the point where religion appears to be misunderstood and not considered, is there any way of going back? Will promotion of religion and religious needs be sufficient to raise awareness? Or have we gone too far in the wrong direction?

Our country has become so very clearly a secular one, by no means a Christian society. With this is mind; is it still reasonable to expect a level of leeway when it comes to religious beliefs and religious freedom?

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