The pain of separation: are we creating an abnormal normality?

When I was at school my English teacher brought many poets to come and read to us. I probably didn’t appreciate then just how lucky I was. I do now. I can remember many and have forgotten more. But one I will never forget because he spoke in the timbre of my own first tongue with a rhythm I related to and a language I felt inside me was Norman MacCaig.

He wrote:

Aunt Julia spoke Gaelic
very loud and very fast.
I could not answer her —
I could not understand her.

She wore men’s boots
when she wore any.
— I can see her strong foot,
stained with peat,
paddling with the treadle of the spinningwheel
while her right hand drew yarn
marvellously out of the air.

Hers was the only house
where I’ve lain at night
in the absolute darkness
of a box bed, listening to
crickets being friendly.

She was buckets
and water flouncing into them.
She was winds pouring wetly
round house-ends.
She was brown eggs, black skirts
and a keeper of threepennybits
in a teapot.

Aunt Julia spoke Gaelic
very loud and very fast.
By the time I had learned
a little, she lay
silenced in the absolute black
of a sandy grave
at Luskentyre. But I hear her still, welcoming me
with a seagull’s voice
across a hundred yards
of peatscrapes and lazybeds
and getting angry, getting angry
with so many questions unanswered.

Norman MacCaig’s ‘Aunt Julia’ is now one of the poems taught in Scottish schools as part of the exam curriculum. I’ve always loved it. Aunt Julia lived on Scalpay on a croft not unlike that of my own family on Skye. She only spoke Gaelic and no English. Again, something that resonates with me as I only learnt to speak English ‘properly’ after I was five. She reminds me of my Aunt Effie in black boots and black skirt, whose apron painted a canvas of egg stain, peat and flour. Even though they could not share a language MacCaig adored his aunt, as I did mine. In words of poignant regret, it was only after her death that MacCaig learnt enough Gaelic to have been able to communicate with her. Now she is absent, his questions lie unvoiced and unheard. There is a separation that nothing can bridge. So many questions unanswered and he is angry.

To be absent from the hands that caressed you every day of your life; to be invisible to the face that woke your dawn with a smile; to be silent to the lilt of voice that spoke as music in your ears; to be distant from the touch that cradled your pain and held your laughter … that is separation.

To be separate from those we love and those whose bone has become the very marrow of our being is an ache which can never be put into words or remedied with any solace. If one has power over it happening, it can only be a conscious and deliberate action if it is for the protection of that very love whose absence creates ache and tear.

This week I want to write about separation.

Getting the balance right between keeping people safe from a pernicious virus and enabling individuals to be restored to the fullness of relatedness was never going to be an easy task. I have been reflecting on whether or not we have got this balance right in the last week partly because of a mounting unease within me and partly because of the tear-inducing correspondence I have been receiving, I have read so many Guidance documents and suggestions from across the world about how it is possible and what steps have been taken to restore a balanced safe normal to older people’s residential care including this week taking part in an international conversation.

I have written before that I think the early measures taken to exclude visitors and shut down our care homes were entirely legitimate and proportionate because the threat of the virus to life was self-evident. It was not an easy thing to do but restricting people’s human rights was acceptable and the right thing to do at the time. As we began to understand the danger of asymptomatic transmission, as a nation we have escalated testing of staff to the level it is now, and we have used PPE, especially masks, to the level we now do. As a result, and because of the wider actions of others in lockdown we have significantly diminished the impact of the virus though as witnessed in the last few days the virus is still present and can tragically still take life in care homes and community.

Last Thursday was the 25th week since the start of lockdown. In the last few weeks we have introduced visiting outdoors and then extended it, started visits indoors and on Thursday there was an announcement about the return of visiting professionals and the greater use of communal space.

But 25 weeks on it is still the case that thousands have not been able to meet up because of the restriction on numbers and the capacity of care homes to staff and supervise visits, because of the Scottish weather and more recently because of local lockdowns and decisions to close care homes to visitors.

There is now a growing anger in the wider care home community about the proportionality of many of the restrictions which in the initial Guidance seemed appropriate. People are weary of being separated and they are struggling to see the justification for what they perceive to be a disproportionate removal of the rights of those in care homes. I have reflected elsewhere about how we have failed to adequately hear the voice of residents and are increasingly, I am afraid, diminishing the human rights of citizens with capacity who happen to reside in a care home by failing to allow them to take decision and action in an autonomous way.

If some form of separation is necessary for protection then the way in which we do it simply has to change.

We have to get better at including and involving families not just to help them understand what Guidance says but to take control and co-write that Guidance so that they are more in control of decisions. Family members are not visitors into the lives of their loved ones they have the right to do be present (with consent) and no-one should diminish that right over such a long period of time without the most profound justification. Clinical paternalism, public health risk aversion or political caution have their place but we must also find a space for the exercising of the rights of residents with capacity to knowingly take control of their decisions and the risks they wish to take providing others are protected. We are witnessing on a daily basis that people are switching off their lives having decided that there is no point in living in this twilight existence of separation and absence. The distressing effects on the mental health and wellbeing of residents and family members alike is  a scandalous trauma.

We have to become more proportionate in the rules and requirements we make. I have yet to see any clinical or scientific reason why a family member wearing appropriate PPE cannot sit alongside their loved ones and hold their hand or stroke their face or feed them their meal. We have to encourage protected touch rather than strip physicality away from encounter.

We have to banish the distance of togetherness by removing the 2-metre distance requirement when people wear appropriate PPE. If a professional carer can be close then why can family not do the same?

We have to get to a stage where we prioritise the new faster tests that are being developed for family members seeing them as critical and essential key workers in the lives of their loved ones.

We have to extend the time that family can be together and get to the stage where there is more control for individuals.

We have to restore privacy to individuals so that they can meet and be together without supervision or oversight. Care homes are not prisons nor are care staff wardens for the behaviour of others.

We have to allow people to go out in the community and not expect them to isolate themselves for fourteen days when they come back to their own home. Which one of us would go out to the shops or for a meal and then imprison ourselves for fourteen days?

There is, I believe, much more that we can and must do. It is clear that we will be living with the pain of separation for some time. We can lessen that pain by ensuring that the times of togetherness are as normal and as natural as they can be. At the moment I fear we have simply created an abnormal new normal.

Donald Macaskill

 

 

Last Updated on 15th September 2020 by Shanice