Creme Caramel To The Rescue

Today was a good day.

No test results yet, of course. That would be too much to hope for.

For a long time now it has been my policy to sample everything they give Rosemarie - apart from the medications. When it was solid food I would check myself whether it was hot enough or cool enough or cooked properly. Were they really chicken goujons or fish? Was that Angel really Delightful? This is how I found out that some of the care workers gave her tea with sugar and couldn't understand why she didn't want to drink it. I discovered most of the meat was the consistency of leather, and some of the soups were far too spicy even for me. The orange juice had that distinctive chemical taste and she much preferred apple juice - a preference which was widely ignored.

When she was moved over to pureed food and thickened juice I continued the policy. At its best the pureed food was bland, at its worst it was cold, often with a thin crust over the top. The puddings were either some anonymous and largely tasteless 'delight' offering, or one of the fortified puddings, called Forticreme. On the whole these weren't bad, although the vanilla flavour was imperceptible and the banana flavour used that strange metallic flavouring that has become the representative of bananas although it tastes nothing like them.

The dietician replaced them with something called Nutilis Stage 3, so I tried some. It looks like a thick creamy yoghurt but it tastes like wet cardboard, followed by a strong but plainly artificial aftertaste. 

The only thickened juice I would have considered having was apple juice. The cranberry was too sharp and I have mentioned the orange juice already. Thickened water looks and tastes like wallpaper paste. Thickened tea....well that is just an abomination.

So as we have been trying to get her to eat and drink again it has become pertinent what we are expecting her to eat and drink.  The plan (among those of us not expecting her to die in the next few days) has been to get her going on thickened juice and Nutilis Stage 3 and work her back up to pureed food. The notes made by the other care workers show very little success, and record her as regularly refusing the Nutilis, or 'keeping it in her mouth'.

I was thinking about this yesterday and trying to put myself in Rosemarie's position. If I were thirsty enough I would probably drink the thickened juice, even if it were the thickened orange, assuming I could swallow anything past the lump of phlegm in the back of my throat. The pudding was another matter: I would have to be very hungry indeed to want to eat it, even though a 150g pot contains 200 calories (and I doubt she knows that).  I remember from periods of illness myself that you can get out of the habit of eating quite easily, and it occurred to me that we needed to be more creative in what we tempted her with. I remembered the SALT talking about using strong and interesting flavours.

So I thought back to what she used to like as treats and went hunting down the Dessert aisle at the supermarket. They didn't have the chocolate mousse I was looking for but they did have creme caramel and I remember her liking it years ago so I bought some. 

I actually took it to the Care Home yesterday but Rosemarie was too tired by the time I was going to give her some. I did mention it to the doctor though, who was enthusiastic about the idea. 

When I arrived today I found Rosemarie not only awake but active, looking around, making noises and smiling. She also seemed to actually be noticing the photographs of her daughter and granddaughter on the wall, and looking at them. I am not saying for certain there was recognition, but there was certainly awareness.

She also looked straight at me, which she usually doesn't do, and again there seemed to be more consciousness there. I think this is due to the end of the Clonazepam more than anything else; I am not going to delude myself and think she is going to get better, but maybe her quality of life may be improving. 

I told her I had a treat for her and got out a creme caramel. From the very first spoonful I knew we were onto  a winner. She actually said "Mmmm". She seemed to swallow each spoonful easily and quickly. And safely. I was thrilled. I left the caramel juice (too liquid for her) but I got a sense that she was still happy to eat, so I got a raspberry yoghurt from the fridge  and gave her that as well. She was also happily working her way through 200 ml of thickened apple juice I had made up.

I was leaving a minute of two between spoonfuls so in between I was talking about her granddaughter and every time I saw her looking at the pictures I told her it was a picture of her holding her granddaughter. Lots of smiles and sounds. I had to be careful not to get carried away and draw rash conclusions.

We had a break after the yoghurt and concentrated on finishing the juice, but after half an hour she still seemed alert (and she was still sitting reasonably upright) so I opened another creme caramel.

This was harder than the first one and it was fairly clear she was getting tired. She had slept very little during the day and not at all since I had arrived, and she must still be very weak. 

We made it to the end though, and I even made a fresh thickened apple juice and started feeding it to her. I had noticed that the 'food kept in her mouth' that I and others were concerned about was often food that worked its way under her tongue or between her teeth and her lips, and she seems to have forgotten how to use her tongue to collect the food and reposition it for swallowing. I found that giving her a spoonful of juice helped to flush this food out, and followed this strategy quite successfully.

So. Two creme caramels, a yoghurt and 300 ml of thickened juice. Doesn't sound much but for me it was excellent progress, and the quality of her interactions was the icing on the cake.

And she let me kiss her goodbye on the lips, and smiled at me when I left.

Maybe I will risk a little more hope.