A Family Reunion

"Find your tribe", it's the advice I give the many parents of children with additional needs who contact me.  It doesn't matter if you child has a confirmed diagnosis, you need to find people who "get it", who understand what it's like to live 24/7 with a child who has taken you for a ride on the extreme parenting roller coaster.

We were lucky (I'm ever the optimist), Daisy received a confirmed diagnosis of Costello Syndrome when she was 6 months old.  At the time she was one of the first children in the world to be tested for the sporadic mutation on the hras gene which causes the syndrome, at the time we were told that it was so sporadic the chances of having a child with Costello Syndrome were 1:1.25million.

Now we are four

"a third of our family has gone..."

My eldest son has aspergers.  His directness and honesty can be bluntly refreshing.  It's true, we are now a third smaller, four instead of six.

The past year, since Daisy died, has been spent trying to adjust yet again to our new family dynamic.  This summer it really came together, we have reformed as a unit of four, all of us intent on our paths, strongly looking forward, resolute to keep going.

I feel that we have turned a corner over the past few months, accepting where we are now, starting to look forward, beginning to make our way again.

Happy Birthday you imperfect, beautiful thing #NHS70

Happy 70th Birthday to the NHS.

To me you are like a favourite aunt, cantankerous, imperfect but full of love and always there when you need them.

I truly believe that without the NHS we would not have had twelve wonderful years with Daisy.

NHS doctors and nurses cared for me when I was so poorly and pregnant with her.  She was scanned and monitored and eventually the decision was made to deliver her by caesarian section.

It's never about giving up

Palliative Care. It's been in the news a lot this week.  And as I've seen yet another case of a child who needs a referral to palliative care being played out on social media I realised how little people really understand by the term.

All this week I have seen the negativity associated with the words and it has shocked me.  Because the perception that those people on social media had on social media bore no relation to the reality we had experienced.

We knew from the beginning that Daisy was life limited.  That she would not reach adulthood.  She was born with a sporadic gene mutation that increased her risk of cancer, sudden cardiac events, complex disabilities.  We know that many of the children with the same mutation do survive to adulthood, there are some who are in their forties even.  But Daisy was always going to be different.  She seemed to have an extreme form of the syndrome, potentially a secondary undiagnosed syndrome at play.  It was clear that there was too much going on and too much need for constant medical intervention to be conducive to a long life.

Andy and I accepted that from the offset.  We knew our time with Daisy was finite.  We were just determined to make the most of our finite time with her.  And that's where palliative care was so important.

Daisy was referred to the hospital palliative care team when she was seven.  I, like many others, assumed that palliative services were only brought in at the end.  I now know so much more.  That early intervention by palliative services was crucial, it contributed to ensuring that we were able to focus on Daisy's quality of life.  In fact the words used regularly by the consultant caring for her were "symptom control".  Daisy's pain was getting out of hand, she was on so many drugs it was difficult to know what was a drug side effect and what was pain.  With the help of the palliative consultant we were able to wean Daisy off some of her drugs so that we could identify which were the most effective in treating her pain.  A symptom care plan was developed so that everyone caring for Daisy understood what medication and doses were available and how to escalate them.

Some nights at home when I struggled to control Daisy's pain (her pain was always so much worse at night) there was always a member of the palliative team on call who could advise me.

We discussed our priorities for Daisy.  Optimising her time at home, minimising her time in hospital, maximising her quality of life and preparing plans to ensure that when the time came we would know and we would be able to support her in having a dignified death.

We made it clear that we wanted to ensure that Daisy was able to do the things she wanted to do; go to school, spend time with her family, be a little girl.  With her team we decided that as the window of Daisy being able to do the things she wanted to do closed we would constantly assess the situation.

I look back now and we did exactly that.  Daisy's deterioration was slow but it was obvious.  She lost the ability to walk, she developed severe seizures, her ability to communicate was reduced, she became more and more lethargic but this happened very slowly over a prolonged time frame and with the help of the pallitiative care team both at the hospital and the hospice we were able to support Daisy and optimise her quality of life.

Any procedure, test or surgery was always decided against the main criteria; "Will this improve her quality of life".  She had a couple of big surgeries in her final years, I know that there were discussions at an ethics panel about whether it was right to put her through more major surgery.  In the end we took the risk, her final surgery, while Andy was still alive, made a huge difference to her pain and we were glad that everyone agreed it should go ahead.

We talked about end of life plans.  These were always very open, frank discussions.  The doctors could not give us answers about when she would die or how, they did not know themselves.  She was always defying the odds, she would be overwhelmed with sepsis and we would prepare for the worst and then she would turn the corner.  We knew what all the options were however.  We allowed ourselves to think of the end of her life so that when it came we would be prepared and know what we wanted for our girl.

The irony was that those conversations with the palliative care team were even more important because it enabled Andy and I to be on the same page about how we would support Daisy when she was at the end of life stage.  We both agreed that we would not go down the route of a tracheostomy for her if that was the only option, she was already dependent of 24/7 intravenous nutrition to live and had four other stomas beyond her double lumen hickman line.  At least after Andy died of cancer just before Daisy's 11th birthday I knew that we were both in agreement and these things had been discussed.

Daisy's health deteriorated rapidly after Andy died.  That window of life quality I had discussed with our consultant was closing.  I remember the Christmas before she died, I just wondered how much we were now playing God.  She was struggling to keep going, her frustration was manifesting in challenging behaviour, she was becoming tired, she was losing more and more of her skills, we were losing Daisy.

When Daisy was taken into intensive care overwhelmed with sepsis it was still difficult to see that this was the end.  We had all seen her turn the corner from this point so many times.  But this time was different.  Everything the doctors tried did not work.  They had worked before.  She was struggling and exhausted.  She was sedated and a breathing tube was put into her lungs and she was attached to a ventilator.  I hoped that it would allow her body to rest and fight the sepsis.

But then her heart stopped beating and as I ran into her cubicle to see the doctors performing CPR on her I knew that I had to let her go.  I knew Andy would say the same.

I asked the doctors whether we could transfer Daisy so that our hospice team could come and switch off the ventilator at home.  I knew from previous conversations around end of life plans that compassionate extubations could happen at the hospice so why not at home?  But she was too unstable, she risked  dying in the ambulance en route.  This was not what I wanted.

The doctors successfully started Daisy's heart again but I knew that she was gone.  They talked to me about starting dialysis, about other life support interventions but I knew that our window had finally closed and it was time to say goodbye.

 I let my girl go.

It was the hardest thing I have ever had to do but I know that despite the fact that we were in a hospital, in a highly medicalised setting, we gave Daisy a good death, she was surrounded with love, we had given her everything we possibly could, we had left no stone unturned in ensuring she had the best life possible.

Our palliative nurse was with me when Daisy died.  We had known her for many years.  She helped the other nurses remove the medical equipment, she liaised with the hospice and the undertaker, she knew what to do .

Daisy's palliative consultant cried.  Just like many of the nurses and doctors who had cared for Daisy over the years they had got to know the little girl beyond the patient and they were as devastated as we were.

Daisy was moved to the bereavement suite on the ward and nurses came in and helped me wash her.  That evening we went home .  Our hospice nurse had set up a cold mattress on Daisy's bed and when the undertaker arrived they tucked Daisy back into her bed for one last time.  She was home.

Palliative care gave my daughter a good death.  It gave us options.  It gave us support and most importantly it gave us the gift of time with Daisy.  I accepted her life was limited, deciding to no longer pursue active treatment unless it was to enable her to have a good quality of life was empowering.  It was never, ever about giving up.

I have shared our story because I have realised that there are so many misconceptions about children's palliative care.  The reality is sometimes there is no cure and children die,  sometimes doctors do not have all the answers, sometimes medical science can only go so far.  It's about time we had more open conversations about these issues.

Set adrift

I'm in a no-man's land at the moment.  Set adrift from a place I once knew.  It wasn't perfect, but I was easy in it's familiarity.

For years and years it was Andy and I , together, a team.  We weathered the storms and adversity brought us closer.  He was my best friend as well as my husband, he was the first one I would turn to when I wanted advice, to share good news, to vent, to gossip.  I would joke that I could never have an affair because I would want to tell him all about it.  We were a couple, a team. Our circle of friends was other couples.  We dreamed about the day when we would have our time again.  It was never to be.  Now I am no longer in the category called "part of a couple", now I'm an outsider, an intruder. 

When I walk home across Waterloo bridge there is no-one to meet for a sneaky drink before going home, there's no-one waiting at home to take my coat and ask me how my day was.  I'm in an alien world, I'm having to negotiate a new normal.  I can't remember the last time I went out for lunch or dinner.  We used to try and do that as much as our life with Daisy allowed.  It was our time, a date over lunch, a quick visit to the pub during a hospital stay, a cinema trip when we had a respite stay booked.  It was less time together than most other couples our age, but it was precious time together.

Now I sleep in an empty bed and remember how nice it was to have someone to cuddle up to.  Someone to chat about the day's events to.  Someone to notice if I am down or ill.  To share my happiness, to celebrate my successes.  They seem hollow and empty without someone who really cares.

I'm set adrift in an alien world and just when I thought I knew where I was the world became even more alien.

When Daisy died I lost my purpose.  I lost my job.  I lost my routine. I lost my tribe.

I am no longer a TPN Mum, a Costello Syndrome Mum, an epilepsy mum.  I can now only share my knowledge of what I knew for us.  I feel a fraud in the groups and forums I was once an active member of.  I feel I should leave them, my knowledge is in the past now.

I'm set adrift from the world that sustained me after Andy died.  The world of hospitals, of TPN, Catheters and IVs, of continuing care plans and respite stays and endless battles to sort out all the stuff that was part and parcel of Daisy's life.  It gave me focus and distraction after he died, I needed to keep going for Daisy, it was my familiar world and caring for Daisy, for all my children, was my priority.

Now Daisy is gone, leaving an unbearable void. 

Her death has blown me off course. 

I've been trying to find a new place to settle.  I miss my old world so much.  I miss being a wife.  I miss being a warrior for Daisy.  I miss the people who were part of that world.

I'm hoping that 2018 brings us some stability.  Some respite from the storms.  I need to find my new normal, I need to find who I am now that my old world is no longer there for me.

Deck the halls

It was always our rule to wait until 12th December to put our Christmas decorations up in our family.  That's my dad's birthday.  Even though my dad died seventeen years ago we stuck to that tradition for a long time.

Until of course Daisy came along.  Like many people with a learning disability, Daisy was obsessed by Christmas.  The Singing Hands Christmas DVDs were played all year in our house and lists to "ho ho ho" were scribbled whenever Daisy had access to paper and pens.

As soon as Christmas decorations appeared in the shops her excitement would mount to fever pitch with a constant demand of "where tree?".  Most years I was able to hang on until the earliest days in December but last year Daisy wore me down.

Last year our tree went up at the end of November.  Last year had been so tough for us all, trying to come to terms with life without Andy.  The Christmas after Andy died it was such a blur that required superhuman effort to get through, we hadn't even had his funeral at that point.  The Christmas Andy died was something just to be negotiated.

So last year I wanted to make up for things, I wanted to make it doubly special.  Just as I had all those Christmases after Daisy was born, so aware that her first Christmas was spent in hospital and our family was apart on Christmas morning.

Always on a Friday evening.....

I had a dream the other night, it's one I have quite a lot .  The one where I am on my own at home, doing Daisy's IVs late at night and I go to the drawer to get out some more syringes and there are none there.  I feel that familiar panic, "what do I do now? , it's the middle of the night, the children are asleep, I'm on my own, how will I finish these IVs?  They are time-dependent, if I don't get them done now then the schedule will be thrown, putting Daisy at risk....."  I wake up, my heart pounding.

Not too long ago this wasn't a dream.  This was my reality.  24/7 worry.  Constantly topping up the medical supplies, trying to forecast how many syringes, needles, saline flushes we would need, whether the doctors would change the dose and this would throw my calculations and we would be short. 

There was nothing more satisfying to me than a tray of IVs that I had draw up myself, quite frequently there were 2 trays worth to be drawn up and administered.  It kept her out of hospital.

Be careful what you wish for

Christmas.  For Daisy this was the most important time of the year (closely followed by her birthday, and then everyone else's birthdays).

 The build up started in the summer.  With the demands for me to write lists for "Ho Ho Ho".  She loved to send letters folding up the pieces of paper she had scribbled on and demanding a stamp so that they could be sent (quickly please mummy)

The Singing Hands Christmas DVD would be on constant loop and gradually over the months excitement would build as decorations appeared in the shops and the rest of the world caught up with Daisy's festive enthusiasm.  Last year I even broke my absolute rule and put the tree up in November, it had been getting earlier and earlier each year and last year was the first Christmas since Andy's funeral and I was prepared to do anything to make it special, including giving in to Daisy's demands and putting the tree up before December.

I'm so glad I did.  I'm so glad I trawled the internet trying to get hold of the Baby Alive doll she kept watching You Tube videos of.  I'm so glad she dressed up in her Christmas hat and visited friends,  delivering cards and presents.

visiting the GP surgery to deliver cards to our friends there

An anniversary gift to Andy

The best piece of advice I have ever been given was by a colleague when I was working at Hewlett Packard.  I really wanted a global role and to spend more time working internationally.  "Decide what you really want and make it happen" she said "otherwise you will just make an excuse".

This has become the mantra for how I have lived my life ever since. (I got the role by the way).   It's what has helped me to develop the resilience and drive to get through some of my toughest times over the past few years.  

I wanted to be the best possible mum for Daisy, I wanted to make sure that our other children did not miss out on childhood, I wanted to ensure our marriage would survive...

After Andy died I was determined to write the book that he so wanted me to write.  I wanted it to be published by our 25th wedding anniversary, my gift to him.

So young! 12th September 1992

I have written a book

"You should write a book"

I've lost count of the number of people who have said that to me over the years.

So I did.

https://www.stephnimmo.com/buy-the-book

I promised Andy I would.  I promised I would capture our story and share it so that people could understand that we really are ordinary people thrown into extraordinary circumstances.  I was no different to thousands of other working mums in the UK, trying to juggle a career with childcare.  Until Daisy came along, and my world changed overnight.

It's experience that has shaped me and given me the resilience to face the challenges life has presented over the years.

That's why the book's strapline is "It's not the cards you're dealt, it's how you play them"

Andy played poker and he knew all too well the game was more than the hand you were dealt.  I hope I have done our story justice.  The people who have read early edits seem to think so.

My book is being launched on 12th September on what would have been our 25th wedding anniversary.  It's my gift to Andy and a legacy to our children.

You can pre-order a copy before the launch date and receive it the day before.  For all pre-orders I will donate 5% of the rrp to our hospice, ShootingStar-Chase.

The book will be available to order from Amazon and all good bookshops on the launch date.

 International orders and ebook orders will be available from that time too. An audiobook is in the pipeline for release at a later date.

In the meantime if you are based in the UK and would like a copy, please click on the link below.

https://www.stephnimmo.com/buy-the-book

The long goodbye

We took Daisy back to school for her funeral, one last trip to the school she loved and had attended from the age of three.  I wanted to hide under a rock but because Daisy touched so many lives it was important that everyone got a chance to say goodbye.

We did her proud.  My beautiful rainbow girl even arranged for a rainbow to appear over the school at the very end.

Coming to terms with it all

It's so hard to believe that Daisy has gone, that we will not see her any more, that I won't hear her call out "mummyyyyy!!!!!!!".  She was the centre of our home.  Everything revolved around Daisy, because she insisted it should.  Her siblings were at her beck and call, in and out of her room, sorting out her ipad, responding to her demands, cuddling her, just being there.  That's what Daisy liked more than anything, to know that we were there.  She just needed to have us around.

Over the past couple of months she had been spending more and more time in bed or lying on the sofa, with her ever present ipad, she liked to observe the domestic chaos of our home.

And now this focal point has gone.  And we wander in and out of her room like lost sheep.

How can it be that in the space of less than fourteen months we have gone from a family of six to a family of four?  The house is too quiet.  The washing basket a testament to the reduced numbers.

Daisy passed away on the intensive care ward at Great Ormond Street hospital.  The team did everything they could but in the end it was Daisy's time and she was tired.  She had been tired for a while.  I knew it was coming.  But even when the end came it was such a shock.

We moved her to a lovely room the hospital has on it's intensive care wards.  It's the room for the children who have passed away.  There is no medical equipment, they have made it as homely as possible.  In this room we shed our tears for our girl and kissed her goodbye away from the beeps and alarms in the main ward outside.  The nurses washed her and thanks to our hospice team we then brought her home for one last time.  She just wanted to come home.

Our hospice at home nurse met the boys at home and got her room ready, setting up a cold blanket on her bed.  Xanthe and I followed behind, bringing an empty wheelchair and a bag full of memories.  The funeral directors who had dealt with Andy's funeral the previous January brought our girl home and she spent the night in her bed, surrounded  by all of her favourite toys as we drifted in and out, each spending quiet time with her, stroking her face, hardly able to process the reality of what had just happened.

The next day she was taken to her beloved hospice, ShootingStar-Chase, as we always knew she would.  She stayed on her cold blanket and rested in one of the bedrooms as the special chilled bedroom was already occupied.  This was a better option for us as we could sit in Daisy's room with her and in time allow some close friends to come and say their goodbyes.  Xanthe and I chose her Princess Anna from Frozen dress to wear and my friend Sam brought a beautiful flower crown of fresh roses and eucalyptus.  We sat with her smiling and laughing and remembering so many happy times.

When a child dies and is resting at the hospice the team hang a butterfly outside the front door.  For many years I visited and saw the butterfly, and then it was Daisy's turn.

The hospice seemed so quiet without Daisy, without her pumps beeping or her constant presence checking what everyone else was up to.  I stayed in one of the parent flats and being there cocooned me from the outside world and allowed me time to process what had happened.

But I knew we had to face the reality so last Friday Daisy was moved to the funeral directors and tomorrow I will visit and tuck her in for the last time,  surrounded by toys.  On Wednesday we will take her to school for a final journey and hold her funeral there, it's only fitting that Daisy should do things differently after all.  Her cremation will be held privately with just myself and the three children on a separate date.

We had twelve wonderful years with Daisy, she taught us so much, it's time to let her go and say goodbye.  We will do her proud.

This is the link to the page for donations in Daisy's memory to our hospice

https://www.justgiving.com/fundraising/DaisyRoseNimmo

We are a family, not a cost

Sometimes it feels like I'm a character in some Orwellian nightmare.  Not because of losing Andy or because of any of the children's issues but because my life, my plans, my hopes are all controlled by someone called "The Commissioner"

The Commissioner is a faceless person, they sit in an office, they are not always the same person,  they change frequently.  I have rarely met them but they know me, or rather they know my daughter.  They don't know her name, just her initials.  It's better that way.  The more you know about someone the easier it is to become emotionally involved.  And The Commissioner doesn't want to become emotionally involved.

The Commissioner holds the budget.  They look at their spreadsheets and they see the big figures and wonders who is eating up all of their budget, who is this very expensive person? 

Talking about it doesn't mean it's about to happen

I know I talk about death a lot in this blog, but everyone who knows me personally also knows that I am the most optimistic, positive person out there.  Because I talk about death doesn't mean it's going to happen imminently,  it just means that when I die I will, as the British so quaintly say "have my affairs in order", as you can imagine my affairs are somewhat complicated so all the more reason to make sure they are in order.

Death and taxes, they are the most inevitable things about our life on earth.  Yet people who will easily visit an accountant to manage their tax affairs would not consider going as easily to a solicitor to sort out their will.

London Marathon 2016: Job done.

2016 London Marathon done, not a personal best time but pretty decent at 04:24 given everything else I have had on my plate.....

It was emotional at points, being out on the course for over four hours gives you a lot of thinking time but I was lifted by all the people lining the route, especially my friends from ShootingStar-Chase Hospice and from the Wimbledon Windmilers Running Club.

It's only been 4 months

It's only been 4 months.  4 months since I last held Andy's hand, 4 months since he was in this house. In the days and weeks afterwards I was swept along by the wave of practicalities, the memorial, the funeral, the paperwork.

In the past four months I have been grateful in many ways for the challenges and distraction of keeping the plates spinning with my family.  The week after Andy died it was Daisy's birthday, then Christmas, New Year, the final goodbyes, hospital appointments for Daisy, meetings at the children's schools and colleges, two more birthdays - Theo is now 19, Xanthe turned 17, Easter, Valentines, Mother's Day.

It's about time we stopped treating disability issues as an afterthought

A couple of weeks ago I decided to take Daisy to an inclusive Dance & Singing workshop at the Royal Festival Hall on the Southbank in London.  I had seen it advertised the day before and thought it would be a fun thing for us to do together on the Saturday morning.  We live in London, we have an amazing mass transport system, except, of course, if you are disabled like Diasy, then getting from A to B involves a lot more planning and preparation.

22nd March 2016

Today I was supposed to be in Brussels.  Today was supposed to be a day just for me, a first chance to get away with a friend and have time to wander, shop, visit museums, eat, drink.

Today ordinary people were going about their business when their lives were shattered by terrorist bombs.  They left their homes, their loved ones, never to return.  All over the world this is happening.  Not just in Brussels today, in so many cities lives are being changed immeasurably, forever.

I could have booked onto an earlier train, I could have booked a flight instead of the train, I could have been in Brussels when the bombs went off.

 When the first messages began filtering through about a bomb in Brussels airport we were already on the Eurostar train, with five minutes to go before departure tweets started coming through about further bombs on the underground and we took the decision to get off the train.  This was all to the great surprise of our fellow passengers and the platform staff, seemingly unaware of what was unfolding at the other end of the line.  Being a parent of a child with special needs you think about scenarios that other people probably don't have to contemplate, my main concern was being stranded in another country and not able to get back for Daisy.

 As we go about our daily business none of us know what is around the corner.  Today I was fortunate not to be caught up in a terrorist atrocity, my children were spared the stress of worrying about where there mother was and when she would come home.

I spent a lovely day in London with my friend, rather than being angry that our plans had been ruined we were grateful that the sun was shining and we were able to enjoy time in our wonderful city.

Tonight I'm thinking about the families in Belgium who never got to say goodbye.

Don't leave things unsaid, don't live with regret, don't live with fear, life really is too short.

Memories, milestones & wishing time would stand still

So we're mid way through March, spring is definitely here in London.  Yesterday I did a 20 mile training run in preparation for the London Marathon.  The Thames towpath was slowly coming back to life after winter, hawthorn blossom, clumps of daffodils.

Easter is looming full of rebirth and new life, but I want time to stand still, I wanted time to stand still from December last year.

I'm not alone in this, a recent conversation with another woman  also widowed prematurely in 2015 confirmed she felt the same as me.  We both discussed how New Year's Eve had affected us, I wanted the year to go on forever because the chime of the bells at midnight meant that we were no longer in the year he had died, that it was already in the past, she felt the same, it was a relief to know I was not being irrational.

One Month. One Week. Bowie.

Today is a sad day.  One month ago today I held my husband's hand as he took his last breath.  I told my children that their daddy had passed away, I tried to help my learning disabled child understand that daddy was not coming back.

A week ago we held his funeral.  We struggled through my daughter's birthday, Christmas and New Year before we could say our final goodbyes.  We had an evening of celebration on Saturday 2nd January filled with laughter and stories, eulogies of hope and pride.  His funeral on Monday 4th January was when it hit me.  He was not coming back.