This was quite a speedy read as it had me engrossed and also aghast at the rapid decline described and the decency in dealing with such a situation. There is overall a sense of calm and appreciation of quality of experience.
This lady, "Ulla-Carin" begins with a burning pain in her right hand on page 3 when rowing at the start of this account and this possible peripheral injury eventually becomes suspected to be a sign of something more sinsiter. Three months after suggesting to her doctor, following internet research, that she may have Motor Neurone Disease (or Ameliotrophic Lateral Sclerosis, as it is referred to in this Swedish translation - the American term) this diagnosis is confirmed on her 50th birthday. A doctor in Umea states "The worst diagnosis one can give a person. Fifty per cent die within eighteen months of diagnosis." Seven months after diagnosis Ulla is in receipt of palliative care. This from a lady who at 48 and 49 was bending backwards and standing on her head. A lady who trained for five months as a physiotherapist on a geriatric ward, was disappointed in some aspects of treatment and chose at this point to become a reporter to give an account of how some situations really are, going on to be a newsreader on Swedish television and then work in journalism in current affairs.
There is detail of the path of impairment. Her right hand droops and her fingers stiffen - page 24 - then she sees an occupational therapist who fabricates a splint for her from thermoplastics and reassures her that it may heal in time and as a doctor she cannot diagnose. She has purchased a button buttoner, tin opener, tongs, an angled knife, a pen and scissors from the "handicapped shop." Having found fault with Canadian needles when sewing, her potato peeler when peeling potatoes and pens when writing she acknowledges reduced strength. She tires easily, trips over and has a tightness in her shoulders so she goes to physiotherapy to have further assessment and treatment.
She is frustrated she cannot wrap Christmas presents (page 21). She celebrates managing to fasten her bra with her bad hand pushing the eye to the hook whilst lying on her bed (page 30) and she resorts to washing her left armpit with her left knee (page 34). The sensation she describes in her body is of "bubbles, fishtails and bees" (page 31). As her energy levels decline she feels that for each day of effort she needs two days to recover from this (page 48). There is a sense of gratitude that she can still wipe herself (page 51). She feels she has lost her right hand and her left hand is also weakened (page 60) yet she manages to celebrate getting two bullseyes with this left hand in a game of darts. There are frustrations about obtaining a carer and she has to answer questions about how long it takes her to dress and she explains she cannot at all without help. Social security want a time putting on things and her friend asks if they want to know how long it takes her to change a tampon. Doctors certificates and occupational therapy reports are presented to explain that she "cannot even pick her nose" and eventually with a thick skinned approach to bureaucracy her care is approved. She then loses her speech and has just 3 fingers that she feels of use (page 73), eventually just using her middle finger really (page 105). Knowing respiratory difficulties are usually a cause of passing, she finds herself at 54% of breathing ability (page 83) and preparing for the potential of a ventilator to help with this. When her weight drops to 49 kilos it is time to consider a feeding tube (page 138). She enjoys a treat of a last meal to mark the end of eating (page 143). Her concerns are about ability to press a button (page 147) and she talks of feeling trapped in her body. Yet with humour she jokes, when doctors say there are "secondary benefits to illness" regarding extra visits, that she wonders what the primary one is. She does describe laughter (albeit a bulbar effect) as being a blessing of this condition though (page 72). She also says that she would not wish to be without this part of life. She feels that she is living in the present for the first time and she states "Death has brought me closer to life" (page 173).
She takes opportunity to make arrangements for family, seeking good advice for how she goes forward. Her older daughter Ulrica helps her with make-up (page 88) and extracts of positively framed letters laced with metaphor from her younger daughter Carin (aged 21 at the time) are featured. Her older son Pontus develops a system of blinks for communication in advance of speech loss, with three blinks for "I love you", two for "yes" and one long one for "no" and later humorously adds in an eye roll to request "pocket money, please." Her younger son chivvies her along by saying that "every second is a life." Special children's trauma therapists advise her how to help children deal with a parent who is terminally ill (page 80).
She describes how she herself copes with her sense of entrapment. "A lot of dexterity exists in the head of a paralysed person." She imagines herself doing things she once did to amuse herself, drawing on her memory.
When carers assist her she feels adrift as it were with them playing the part of her oars. She also says she does not mind if they talk over her as she is appreciating the passivity of the process of being helped perhaps. She does talk of enjoying receiving assistance with showers.
She meets with a lady whose books she has read and discusses theology, discovering this lady is Jewish and whilst she once focused on being clever she now focuses on being good she says and provides inspiration from a Holocaust survivor who talks about death being part of life, how we live a whole life every day and how it is possible to have dignity in death. As a Christian (thanks partly to each of her Grandmothers) Ulla is grateful for support from the clergy with extracts of Job used to explain to her how it is okay to doubt (as even clergy do) and to be angry. She ponders what death is - being in a different dimension with the body returned to earth and the personality or soul going to God. She tells her son that it is part of God's plan (page 43). She is reassured by her Chaplain that some good will arise and she is reminded that her life is more than this moment and more than her illness and encouraged that she should take opportunity to have her goodbyes said. She is philosophic about adversities and when she tumbles onto a vase of roses, cutting her bottom and requiring stitches, she states "Despite everything, roses are still roses." She describes getting more vivid dreams and noticing life with enhanced attention to detail. She also discusses her imminent death with friends and how she wants things handled (page 112). She talks of a quality of death as well as life and of reassurance that she should not have to experience pain with help at home from an Advanced Care at Home team. Friends rally support. She values it when a colleague comes to read her a novel (page 169) and another friend provides her a therapeutic massage (page 172.) She values that people give her the gift of their time. Her husband (a doctor treating burns patients) reassures her or his intention to keep his vows and support her to the end and she also speaks of her brother's support.
Page 168: " 'To work as a doctor is a privilege, with all the contact it gives, all the insights into life, dying and death. Sometimes you find it extremely moving, at other just very moving.
'It affects me as a human being. Perhaps I can begin to understand what is important in life and what means less.'
I, so deeply involved in how my life is ending, am grateful that these people exist."
Ulla takes the opportunity to raise the issue of how it is that whilst half of funds goes toward nervous system disorders, only 5% of research funds are aimed in this direction.
She describes how she is well supported with equipment which her sons take great delight in, using the ramps she gets for toy cars and as a mini golf incline. She benefits from a leather armchair donated from a man who had ALS/MND and donated it for use of others in receipt of this diagnosis. Her bed is a hospital bed from the county council with, as she describes it, black balls that fill with air. She has her house adapted with a stair lift (60,000 kronor), a turbo wheelchair (worth 100,000 kronor), nose-operated computer (20,000 kronor), a page turner, which sometimes has problems with pages (20,000 kronor) and disability adaptation of the home (at least 80,000 kronor) . These items are not all self-funded, thankfully.
She explains ALS as having too much glutamate on the brain and breaks down the definition of the terms as a lack of nourishment to muscles on one side of the body (how it initially begins) with nerve cells replaced with connective tissue. She is told how it often strikes high achievers.
This book is quite an achievement in itself in describing a deft adaptation to a hard deal to accept and one that should surely be inspirational to others.