It'll all work out

Seeing someone deteriorate is tough, there's no doubt about it. I still carry with me memories of my active, loving and caring grandma. For the last three years especially I've been experiencing her decline: physically and cognitively. I only see her a couple of times a year, with her living alone in Egypt, but it's still difficult to see.

My grandma (or 'Teta' in Arabic) has been widowed for exactly 30 years and has lived alone all this time. In the past she epitomised independence and strength, with my dad emigrating to the UK a year after the passing of my grandad, no male figure back home. She'd managed to find things to occupy her time, whether that was knitting or travelling the world and meeting with friends. Now, she's distanced herself from all kinds of social (or not) activities and has been homebound for a couple of years. Teta's visits to the UK, a chance to see her only child and grandchildren, have stopped, and her car is parked away in the garage, collecting dust. She receives a couple of phone calls from family members a day, but beyond a domestic cleaner and makeshift carer (the 'bouwab' - a caretaker/security presence for the apartment) she rarely sees anyone else. With limited mobility and worsening physical condition, loss of hearing and diabetes, depression and social isolation are inevitable. Her fridge accomodates now only cheese pies and milk - virtually nothing else in sight. Long gone are the days where she'd eat her five-a-day and cook her own meals. Lately, dinner - her only meal - consists of a chicken wrap from a shawarma shop. Every day.

Her sleeping has no pattern and if uninterrupted she can spend essentially the whole day to'ing and fro'ing between her bed and the toilet, occasionally making a visit to the fridge. I find it striking to see how much her physical decline has had an impact on her mental state, and vice versa.

The drastic changes all started after a fall in 2015, caused by what’s believe to be a heat stroke. She was left unconscious on the floor for hours before the door was knocked down by the bouwab, coming to her rescue. Following the incident, a doctor visited, stuck to his routine and brought in an IV bag - but that was about it. Subsequent visits to a hospital or from a medical professional since have been infrequent to nonexistent. Now, next to her are two plastic bags with a cocktail of pills and tablets that she's able to impressively keep on top of without much assistance.

Even though so much has changed since the heat stroke, somehow our family has managed to neglect her, and I don't think the word 'neglect' is an exaggeration. Her only child, my dad, doesn't enjoy visiting Egypt or having the burden of care, and travelling to the UK exhausts her - besides, she doesn't want to leave her home. And like so many people, my grandma doesn't like accepting help. So we carried on living life, aware of the issues but ignoring them.

In May 2018, I made the trip with Dad to check on my 78-year-old Teta. I'm not sure what the main motivating factor was, but the fact my grandma is no longer able to take care of family business, such as rental of apartments, played a big part. She was beginning to confuse 100 EGP and 10 EGP notes and struggled to keep in tune with wages of workers.

In the short periods of time I've had to 'care' for her (in a very loose sense), I've already noticed how draining it is to look after someone. In the first couple of days since arriving I did little more than offer her water, adjust her bed or refill her bag of cheese pies, but I'm already exhausted. It takes lots of patience and other qualities that are beyond a lot of us. She expresses her gratitude and I realise what I've done is virtually nothing. It's just five minutes of effort for someone who I care about. And in these first two days, I've already noticed considerable improvement in terms of her movement and awareness of surroundings - a product of our company and minimal level of care.

On the second day, Teta's only living sister came to pay a customary visit. My grandma told us about another fall that she'd had a few days prior to our arrival, which was news to everyone. In a sense, it was a timely fall. With my great aunt there, we sat with the goal of finding a solution. Teta couldn't carry on living alone.

Previously, she'd expressed apathy for carers, not just because she didn't like help but because she didn't trust anyone living in her home or even visiting for half a day. Ok, so what other options did we have? We sat in the living room, the three of us almost talking about Teta and the situation as if she wasn't in the room - partly because of her bad hearing and partly because her inability to fully keep up with conversations and her worsening short-term memory.

Incidentally, my grandma herself came up with the idea of a care home. It would be perfect. A care home was the best way to ensure there was someone qualified to look after my grandma, while having other people around her for some company. We all agreed, and later that night my great aunt told my dad about a place she knew.

The next day my dad and I went to visit this care home - in reality it was a private rehabilitation centre/hospital that specialised in physiotherapy and care for older people. Even better than a care home. They had physiotherapy rooms, on-site geriatricians, nurses and doctors. They promised social gatherings, three healthy meals a day, a gym and a carer with her 24 hours a day. In short, this place seemed to tick all the boxes. It was everything that she was lacking. We were to take Teta in a couple of days with the prospect of admitting her there while we were still in Egypt for the week. It would give her a chance to adapt without being thrown into the deep end alone. It had all worked out, so far at least.

It seems perfect. Then why is there an element of guilt that I carry with me? It really is the best solution. Yet it still feels like we're shipping her off, settling for the easiest way out. We can go back to the UK knowing that she's fine and in someone else's care. Wait, then why am I feeling guilty? Yes, we're offloading our issue onto someone else, in some way, but the key is that we'll feel safe and relaxed as a result. Not because we've done our duty and gotten rid of any responsibility but because she's being taken care of by qualified people. Not by the makeshift carer, while she lives alone, five floors up in an apartment behind a now-reinforced door. We were never around to look after her, so it's not like we're leaving her in a hospice to see her final days out. But it still feels like it.

Two days before we're planned to visit the hospital, this time with my grandma, she begins voicing her fears. I try to be sympathetic - it's only natural that after more than 40 years of living in your home, you'd be weary about suddenly leaving. We try to reassure her that it's only temporary, until she feels better and can live independently again. This is the only viable option, too, we remind her. And she accepts that she's not well enough to continue living alone. But she worries about who's going to look after the home while she's gone, how we're getting to the place (who's driving?) and what she's going to wear. She hasn't been able to bathe herself for some while, and without a carer, who's to do it for her? Some of her concerns are justified but I can't help but feel that others are just ways of deflecting her main anxieties. Like, how we're getting to the hospital should be the least of her worries. But if you were to leave your home for an alien place, knowing very little about it while feeling vulnerable and exhausted, you'd do your best to throw any spanner in the works.

My dad and I hopelessly try to look for a change of clothes among heaps of bags and to operate her old-fashioned washing machine. And although he's good at hiding his emotions, it's easy to see what kind of effect the situation is having on my dad too - my mum tells me on the phone about her relief that I'm in Egypt with him. Just because going to the hospital is the best option for all, it doesn't mean it's an easy one. I escape the reality by listening to music and writing, him by smoking cigarettes in his room and Teta by sleeping most of the day.

When I wake her up on the Thursday we're due to go to the hospital, she's puzzled. "What hospital?", she asks. She then tells me that she's barely slept and that she has horrible back pain. But she perseveres, with some encouragement from my dad. Her mood improves and optimism increases as we leave the apartment and make our way to the hospital - but the complaints are still persistent even once we've arrived. She hasn't eaten all day, she's been waiting to see the doctor for 10 minutes and her back still aches. She's always been the type to want things in a certain way and has high levels of expectation, which is what can make spending time with her difficult. But we persevere.

The doctor asks some questions, both to my grandma and to my dad (in her absence) and they take her up to her room. As soon as she's upstairs, she has a long overdue shower with the aid of the carers. I wait in the room next door, watching the TV as a distraction. Some minutes later I'm kicked out and made to wait in the lounge area while the nurses help her change. My dad, the bouwab and I sit in the lounge, waiting more. The TV here doesn't work, but for the static. It's not long though until one of the nurses calls, saying Teta asked for us. As I walk in, she's gleaming, in a new nightdress and with shiny hair still damp from the shower. The smile is enough to put me at ease.

Next is the blood test (in the knowledge that her last one was two years ago) and some other tests. They ask for any dietary requirements and general preferences, before preparing her first meal of the day, with the goal of long-term weight loss and a generally healthier lifestyle.

"You have to eat it all", she's told by her nurse, referring to the plate of salad and eggs. But the complaining doesn't stop: the eggs are too hot, the water isn't cold enough and the salad smells bad. I'm struggling to keep up, but it's relieving to know at least that she's not afraid to voice her concerns. Earlier, the doctor tells me and my dad about a verbally and physically abusive dementia patient, putting us to ease about my grandma's authoritarianism.

Somehow there's something reassuring about her being well enough to go back to her old ways of brutal, unwarranted honesty and authoritarianism even if it's embarrassing and tiring to endure. My dad shares with me this same sentiment at a later date.

Once she's had her meal, we wait. Not sure for what exactly. But we're waiting. The nurse comes at one point to make sure my grandma is comfortable on the bed and to assist with bathroom duties. The chief nurse and a geriatrician check that all is going well. And it seems like it; even my grandma's complaints have decreased in frequency. We acknowledge that it's a short-term solution until she gets better and can go back to her house, with us in the UK free of anxieties. The first day at the hospital leaves us with hope that she'll get better and go back to her old ways, even if it takes patience and hard work.

But patience is one thing my grandma doesn't have. In a classic twist, the next morning she calls my dad. "What are they feeding me? I'm not happy here. I want to go home". The phone call leaves my dad fed up of her flip-flop emotions and me curious as to what could have happened overnight to leave her feeling like this. When we get to the hospital, we face a new tirade of complaints. She asks us how much longer she'll have to endure this "torture".

The second day sees more of the same. We wait for something to happen as nurses and doctors come in and out of the room, introducing themselves, lingering in the room for a while before disappearing again. A meal comes in, my grandma isn't fully satisfied and makes a rude comment, my dad and I give out a sigh and try to put her at ease.

I begin to see the monotony and repetitive life of being stuck in a hospital - but, really, it's no different from being stuck at home, with no one to direct your comments at or vent to, not to mention feed and care for you. She twice asks when she'll be leaving and twice my dad replies with "until you improve".

Our waiting is rewarded with the physiotherapist who comes knocking on the door. He leaves my grandma short of breath after 15 minutes of light exercises on her hands and legs, and a short walk around the room. It seems like small steps (literally and metaphorically) but compared to when we first arrived, there's a noticeable difference. She thanks God even though she's exhausted and still fed up. The day continues with each of us returning to our temporary escapes: music, cigarettes and sleep.

The third day sees no complaints from me or from my grandma even. Her mental state is miles better and even her awareness, memory and movements have improved. The day is occupied by visits from her sister and cousin, with the latter herself mentioning how much improvement she's noticed. Teta is excited by the prospect of staying here at least once Ramadan ends and improving over time. She starts becoming accustomed to the physiotherapist, the meals, walking to the garden and actually sleeping during the night, not the day (although she tells me that the day does feel longer than usual - not a surprise considering she now wakes up at 8am not 2pm).

As the sun sets - the room allowing us a great view - I'm conscious of us only having two more days left before heading back to Egypt - the mild sense of guilt I carried with me is completely gone and replaced by assurance that I'm no longer the only one at comfort with this solution, but that she is too.

On the fourth and penultimate day, our visit is limited to less than an hour. Our arrival is shortly followed by our accountant's and most of our time is spent discussing business. More importantly she tells us she's doing well and she doesn't seem bothered by our brief appearance. One day to go.

The final day is met with an air of sadness, mixed with fatigue, as we prepare our goodbyes. On at least three occasions my grandma begins a sentence with "The problem with this place is..." Yet she shares the sentiment that this is the best option for her, and we all agree. Late into the night, and with our flight early the morning after, we begin making our way. My dad promises a return in a month and my tickets are booked for July. She's close to tears as we hug her. It's the 100th time we've had to say goodbye to her, but this time it's different.