Navigating the Crossroads of Palliative Care & Dementia: A Poet's Perspective

NOTE: This post is a bit longer than usual & contains a 10 minute presentation.
 
I recently had the enormous privilege of presenting poetry at the 2024 Palliative Care Summit: 'Navigating the Crossroads: Building the intersection between Palliative Care & Neurodegenerative Disease'. The summit was hosted by Palliative Care WA in the Pan Pacific hotel in Perth. I mention this because it's the place I was held in quarantine while my mother died in a nursing home just a few kilometres away. Perth's hard border control at the time was brutal. While many people have understandably just wanted to move on and forget about the pandemic, it's taken me a bit longer to do that. For a long time, the sorrow and grief seemed knitted into my skin. 
 
Of course, I could have said no to the summit. But I sensed that this occassion was bigger than me, that these poems might serve others, that performing them might also help me work through residual grief, resentment, and anger. The poet Bernadette Myers spoke about writing 'occasion' poems. 'This is part of our purpose as poets,' she said.  'Poetry as work in the community wherein we belong and work as speakers for others'. So I said yes to this work in the community. And I'm so glad I did. 
 
There were over 300 people in the Golden Ballroom of the Pan Pacific that day, and a lot of emotion. I don't usually hug crying strangers but I did & there was solace in acknowledging the complexity of our shared experience. There were also many interesting presenters. I listened in awe to keynote speaker Dr. Hsien Seow, Phd. If you're seeking some info on Palliative Care, check out his The Waiting Room Revolution, which includes a podcast hosted by Hsien and Dr. Samantha Winemaker MD, plus heaps of other valuable resources. 
 
I definitely want to write more about the enormity of the day and I'm slowly building a collection of poetry & prose titled ROOM 1824 that documents my quarantine experience. But for now I will share the ten minute presentation I gave. I'm also giving a huge round of applasue to Jo Micallef & the Palliative Care WA team; plus a big bow-down to all those who work with people living with serious illness. #PalliatveCareWorkers #Respect
 
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NAVIGATING THE CROSSROADS: A PERSPECTIVE IN POETRY

 

I’m going to read 3 poems for you today. But first, a little context.

 

We were lucky. Margaret, my Mum, was diagnosed with Alzheimer’s when it was in the early stage so we were able to plan. Having said that, and especially after listening to this morning's speakers, there are things I wish I'd known sooner. Mum lived for nine years with the disease, and died during the pandemic, in January 2022, at the age of 82. Covid travel restrictions meant I hadn’t seen her for six months. And I couldn’t be with her in her final days because I was quarantined, inside this hotel.

 

I was very close to my Mum. I cared a lot. We lived in different cities (me in Adelaide and her in Perth) but we were in regular contact. Before moving into aged care, Mum lived alone, and if she was worried or upset about something she would phone me; or my brother or sister-in-law, who live in Perth. We were her three key supports.

 

I learnt to allow half an hour for phone calls. I learnt to talk about one thing at a time so I didn’t confuse or overwhelm her. I learnt to name her emotions for her:   ‘You sound worried, Ma. You sound angry, frustrated. You sound sad.' And in this way I could calm her. She would often say: ‘I feel better after talking to you, Caroline.’ And that made me feel good.

 

But as the disease progressed, things got harder. No matter how well informed I was, how much research and planning I did, all the organising and problem solving, the phone calls, emails, the interstate travel; even my years of experience as a support worker in the disability sector  – none of it prepared me for the emotional fallout of witnessing the illness in my mother.

 

None of it prepared me for how I was going to feel.

 

The big losses were hard and harrowing – like the first time she didn’t recognise me as her daughter; or having to move into an aged care facility; or how she began speaking mostly in Welsh, a language I loved to hear her speak but could barely understand.

 

The small losses carried a different kind of weight. To the outsider they might have appeared insignificant, like the cups of tea she drank in the aged care facility – white with one sugar – when I knew she drank her tea weak black; or noticing that 2 of the 4 buttons on her favourite black & white cardigan were missing, and no-one had time to tend to that; or realising that she no longer laughed when humour & laughter were such a big part of who Margaret was.

 

Aged Care Facility, Penultimate Visit [published in The Banyon Review]

 

Her plans snag

I interrupt her morning tea

Not sure what to do with

blue-iced pound cake

she wraps it in a thin paper napkin

and offers it to me.

 

Soon she will wander

with undisclosed purpose,

shed lives like feathers

in the facility’s eternal corridor,

burble the language

of winter rivers.

 

I’m almost undone

by her new noise and I gossip

too brightly about birds

and weather, hold her

hand too tightly

as if it were a rare seed.

 

When she leaves the room

I overthink the simplicity

of her closed door.

I work hard to not think

of clouds uncoiling

like rope, of cake

crumbs spilling

on bedsheets

like a host

of poisoned

sparrows.

 

 

 Mum’s final years of palliative care are, for me, forever tied up with Covid-19, border controls, and absence, particularly an absence of touch. In the last two years of her life I saw her mostly on screen – usually once a week for our allocated 15-minute video calls. Covid and W.A.’s hard border meant I could only travel to Perth a couple of times to be with her. One of those times was in July 2021. I hadn’t been with her for 12 months and as you can imagine, the changes were significant. They took my breath away. This is the second half of a long poem that responds to that experience. (This poem won the Mslexia Poetry Award & Woollhara Digital Poetry Award. You can read the full poem HERE) :

 

A Poem To My Mother That She Will Never Read

 

When finally the border re-opens I arrive at dusk.

I hate the locked unit, the nurse’s sterile station. Your life

summarised on a shelf in a lever arch file.

I hate the grey vinyl furniture. Quiet ripe air.

I hate weeping into hospital white sheets.

I watch you sleep with your eyes open.

Shadows congeal in the quiet corners of your room.

Your arms reach for invisible things.

You’re like The Walking Dead except you’re not walking.

I google Finding The Person Inside Dementia I get a theory

of Personal Identity in the tradition of John Locke.    

It goes:

         A person with advanced dementia is not a person.

I can’t find the sweet or funny in that.

 

On a bend in the Swan River near the airport on Noongar country

         an untidy circle of teenagers drink cider against a backdrop of raven sky.

And black swans sleep on the obsidian river with their heads tucked under a wing.

I play angsty jazz radio into a roar of jets.

I am wet with crazy in my good daughter devotion. I wish

stars into kisses that say yes. Wish kisses

into other kisses that hold their breath like

poets hold truth.   Or      Not.             

Ma – Maybe you’re a single syllable dropped down a well?

A heart shot out of a gun?

A blue shoe worn on the other foot?

Between you and me?

                                    I want us

                                    to be us

                                    without all the rest.

I also want warm socks.

It’s three degrees in this river and my words are making me shiver.

I wish they’d stop aching like sad old teeth.

They never tell you about the aching teeth.

How exhausting it becomes to speak.

The sometimes loveliness of sitting in silence with you.

How grief is aeroplane white with too many empty seats.

 

My final poem is called ‘Something Strange Is Going On Inside The Sun.’  The central image is one I read about in a science journal: there is, apparently, a hole inside the sun. Scientists don’t know what’s inside the hole, and it’s getting bigger. As I thought about the growing number of people living with dementia I began to imagine people’s lost memories filling that ever-expanding hole inside the sun. I wrote this poem when it dawned on me that Mum’s dementia was no longer mild to moderate. That Margaret had arrived at the late-stage. That we had arrived.

 

Something Strange Is Going On Inside The Sun (published in SIARAD)

 

There’s a hole in her centre the size of fifteen hundred Earths

and no-one seems to know what fills that hole

and Margaret, who is that woman in your face?

Something strange is going on inside your face

 

And the broccoli grows strange in my garden

leaves wider than the sleeves of a Renaissance gown

but the green heads look demented, deformed

devoured by predators with tiny teeth

and Margaret, I too have become strange

 

I think of death and people dying, all the time

I think of lives lost to dementia, all the time

I hear your memories crack and splinter, shards of people

place and time shot through with foggy darkness

and Margaret, I think your memories are filling the hole in the sun

 

Here is Bryngwran, the Welsh village you were raised in

Here’s your mother, my grandmother, sewing by the light

of a candle. Your father tends the garden

Your brother calls you in from the stream

where you swim with your twin sister

 

Here are your people who grow things

Here your people who make things

who sing children out of rain

who sing bones in to earth to lay them down again

in the land of your mothers, the land of your fathers

 

And that old sun swells with the strangeness

of memories’ broken bones

but I am singing them back

in this poem. And you can call it selfish

but I am singing them back

because I need to remember

who we are in this strangeness

we’ve become

And so I sing …

And I will keep on singing

in sunshine and in rain

and on foggy winter mornings

until you come running like a child

through the fog

to her mother’s open arms,

Ecstatic to be found at last.

 

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Thanks for reading. If you'd like to stay in touch, subscribe to my sporadic Newsletter HERE; or visit my Online Shop HERE. You can also Donate a virtual coffee HERE.

 

much love, Caroline x

 

 

 

 

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