October 28, 2011

I like to eat with Mum at least once a week, partly because her behaviour at meals is changing so quickly. The pushing and pulling of the table is history now. She hasn’t got the strength any more. Correction, she hasn’t got the table. But let me go back a week to when she last ate at a dining table.

When I arrived at the dining room, Mum was sitting with a cup of soup rather than the usual soup plate. This was because she isn’t much of a hand with a soupspoon any more. Mabel had been taking ages to get any soup into the spoon then invariably spilt it onto her bib before she got it to her mouth. Now all she has to do is lift the cup to her lips. The loss in variety is a shame – she gets plenty of cup-to-lip action at tea times.

When the main course came, with too much on the plate as usual, I put the fork into Mum’s right hand. First she raised it empty of food to her mouth. In her own time she speared a slice of carrot and ate that. Then she speared lots of slices of carrot at once, and managed to cram them into her mouth. Quite a good start, though I suspected it was the bright orange color that attracted her eye rather than a liking for the taste of carrot. Perhaps this was why she had already lost interest in the meal and put down her fork. I lifted the fork, speared a chunk of meat of about the right size, then smothered it in gravy. I knew it was tasty and nutritious as I’d already finished my own plateful. She ate the piece of meat so I did the same again and she ate that too. “That’s enough,” she mumbled.

She wouldn’t pick up the fork after that, but she did open her mouth when I presented the loaded fork to her face. As any adult who feeds a baby must know, there’s quite a knack to manipulating a fork or spoon so that it’s the soft food, not the hard steel that makes contact with lip and tongue, and I think I’m getting it. Nevertheless, Mum would only accept three bits of meat this way. “No more”, she said, after that.

Discreetly, I loaded the fork with creamy potato, and after ten seconds her hand moved to the fork and she fed herself. And again when I loaded the fork twice more. After that she wouldn’t take hold of the fork and, after a pause, when I presented a forkful of cabbage to her mouth, she smiled and wagged her finger at me as if she saw through all my old tricks. It was probably like the meals we would have eaten in each other’s company fifty-odd years ago, with roles reversed. However, the expression on her face reminded me of a photo taken at a family meal only a few years ago, when she held up a prawn for my camera with that same mischievous twinkle in her eye.


So I smiled in collusion, left it for a few seconds, and when I next presented the food she opened up without demur.

Focusing on each individual forkful like that, it seemed Mum ate quite a lot. But when I looked at the plate when it became clear, after three quarters of an hour, that she genuinely wouldn’t eat any more, there was still what seemed like a full plate in front of her.

So now here we are exactly one week later. When I arrive, Mum is, in fact, sitting at a table in the dining room, but she is not sitting anything like upright. I try and straighten her out, but can’t seem to do it. It’s a weakness she’s shown before, this leaning alarmingly to the right. She can’t possibly eat in this position, and I can see that soup has been dribbling out of the side of her mouth. A carer – busy overseeing about a dozen meals with the help of the cook – helps me transfer Mabel to the comfy chair in the lounge adjoining the dining room, where they manage to get her to sit straight with the help of a pillow. I know this is where Mabel eats most of her meals now and this is where I expected to see her. Apparently, she’d only been put at the dining table today because it was known I was coming. Well, I can pull up a chair and share the little tea trolley table that has been placed in front of her. If it makes sense for Mum, it makes sense for me. She sips her soup successfully, but not with any sign of appetite.

I make quick work of my soup then when my main course comes I try and feed Mum some of my flan. Sometimes she opens her mouth for the fork, sometimes she doesn’t. Then she won’t even focus on the food and I can move the forkful of nutrition backwards and forwards - or in circles in front of her face - and her eye won’t so much as glance at the food never mind follow it. Altogether she takes about six mouthfuls of flan and/or potato, and the last two of these she spits out. If the part of her brain that used to want food is shutting down, then presumably that’s the dementia creeping on. But I don’t know.

Are we doing all we can to ensure Mabel eats enough? Well, it would help if there were more staff around. Staff levels – that perennial issue. However, because Mabel eats so slowly, as long as whoever is on duty keeps coming back to her with a forkful of food now and again, then Mum may get by. But the carers do need to take their time when they pause in front of her, Mabel doesn’t like being rushed. They need to get their heads round Mabel time. And they need to understand that ‘no more’ means ‘no more right now, but probably a mouthful in a minute or two’.

When I get a chance, I’ll discuss Mabel’s eating regime with a senior carer and the manager, and I know they’ll engage with me in that discussion. Together, we’ll do our best to keep up with Mabel’s ever-evolving needs.