I thirst

There is a horrendous story in today’s papers about a young man who died in a London hospital from dehydration. Throughout a catalogue of disasters and omissions by the hospital, the 22 year old even dialed 999 to try and get the police to get him a drink of water. It is a horrible, horrible story and one which resonates with me too. My father, who has multi-infarct dementia, has been admitted to hospital several times in the past few years with dehydration. The care-home where he lives often ‘forget’ to give him water to drink and as a result he starts to become seriously unwell, fits and eventually is admitted to hospital. Although he is given coffee at certain points of the day and juice with his meal, he has to be prompted to drink it. He forgets to drink what is in front of him.

It is not a huge care issue – to prompt someone to drink. Without the prompting he just forgets. It is not like dealing with incontinence or wandering or shouting which many others in the home do. All it takes is for a member of staff to remind him to drink whenever they pass him. And to make sure that he has a drink beside him all the time. That’s not a big care issue in my books. We’ve even had it written into his Care Plan because for a while there were so many temporary staff nobody knew about it.  But still I will visit and find him with no drink beside him.  He has a catheter so it is important that he drinks plenty fluids. There’s barely a month goes by without him being on antibiotics because of an infection with that and I wonder if drinking more might just help.

We used to always take drinks in for him when we visited but were told we didn’t need to because they would provide it. And sometimes they do. But not always. He has gout too and what is one of the causes of gout recurring? Dehydration. It just seems such a simple thing but somehow it doesn’t always get done.

And hospitals are not excluded from this either. For when he is admitted and is given a drip it sometimes takes 4 days to rehydrate him. Then when he is taken off the drip the problem starts all over again. Water jugs out of reach, full cups of coffee removed because they are cold but nobody thinks that this means he hasn’t drunk anything.

You’d think it was such a simple thing. We are not a developing country; water is freely available. But time and time again I visit people in hospital suffering from dehydration. It is just so preventable and so simple really. Their needs are few. They thirst. Just give them a drink.

7 Up … 56 Up

There is a programme on TV just now called 56 Up. I could be taking part in it. For I too am 56 just now. (Pause to allow you all to gasp with horror… “Surely not, Ruth!”) I have followed it every seven years although I’m not sure that I did watch the very first one when I was seven. So I wondered what I would have had to say every 7 years of my life.

Age 7 – Mum, my sister and I had just moved to Valleyfield Street, Tollcross in Edinburgh and I was walking to James Gillespie’s Primary school over the Meadows by myself. I remember school milk and begging to get a letter to excuse me from it, as it was warmed by putting the crate next to the fire in the classroom. (Yes, a real fire.) If you’d asked me what I wanted to be when I grew up, I’d probably say ‘A man’. I was a tomboy who played with cars and never with a doll. Hobbies: reading Enid Blyton; collecting comics; buying jokes and disguises from joke shop.

Age 14 – Still in Valleyfield Street and still at James Gillespie’s, but this time the High School (all girls). I may have started smoking and other such rebellions (short skirt, multiple badges on blazer, etc) but boys were still a mystery. There was a school trip this year to Switzerland along with boys from Boroughmuir School and I could barely speak to them for shyness. Was feeling drawn to dentistry and medicine but as I couldn’t do science this was looking less likely. Hobbies: reading; movies; music of Marc Bolan and David Bowie.

Age 21 – Still in Valleyfield Street with a husband and two babies. Dreams of being an actress have had to be put on hold but the dream is still there. Convincing myself that having children at a young age means that I’ll still be young enough to have fun when they are grown up. Have worked in the bank and now part time Auxiliary nurse at Simpsons hospital. (As close to medicine as I ever got.) Eldest son is hyperactive and proving to be a bit of a challenge. Nobody agrees with me that it might be related to artificial colouring. Hobbies: knitting; reading.

Age 28 – Divorced and living in Brougham Street, still in Tollcross. Rebellion is my second name. Working part-time in a Cocktail Bar and having lots of fun. Dabbling in New Age spirituality and reading lots about Native Americans and Shamans. Dreams of being an actress have been shelved. Both boys are at Gillespie’s, which is now co-ed, and it is very weird being summoned to the head teacher’s room when I spent so much time outside it in my childhood. Hobbies: reading; Bach flower remedies; crystals; Shamanistic drumming; crosswords.

Age 35 – Still in Brougham Street, but have my own business making and fitting self-adhesive signs with Jenners as my biggest client. Loyal member of St Michael & All Saints across the road from my flat. Have been Confirmed and now read, do intercessions, on coffee rota and help run the Youth Group. Still trying to integrate New Age spirituality and Christianity but finding some Christians rather hostile to the notion. Against the ordination of women because ‘Father says so’ and rather a spiky Anglo-Catholic in love with ritual. Learning how to be an Altar Server – first time for women in our church. Passionate about Cursillo (renewal movement in the church). Hobbies: reading; church; cross-stitch; making jewellery.

Age 42 – Have been made homeless and am now living in a council flat in Hyvots, Edinburgh. In my second year at New College, University of Edinburgh studying Divinity and in my first year of Tisec (Theological Institute of SEC) training to be a priest. Working part time for The Rock Trust working with young homeless people. Still dream of being an actress but wondering if priesthood will fulfill at least some of those desires (standing up and showing off in front of an audience). Not able to watch anything on TV except for Casualty once a week because every night is revision night. Loving it! Hobbies: church; theology; reading fiction during holidays; exploring churches.

Age 49 – Living in Linlithgow as priest-in-charge of St Peter’s & St Columba’s Bathgate. Have been curate in Perth but glad to be nearer home to visit sick parents. Dad is in a Care Home in Edinburgh and Mum has been diagnosed with cancer. Juggling two churches is hard work (12 hours days not unusual) but loving being a parish priest. Surprised at how much I love working in a small town where everybody knows your name and stops for a blether in the High Street. St Peter’s has just been redecorated in shades of lilac. Also working as Diocesan Co-ordinator of CMD 1-3, General Synod member, on Mission and Ministry Committee and Board, and on I&C Board. Hobbies: reading; romping round churches.

Age 56 – Now in Falkirk at Christ Church, having done nearly 5 years in Portobello, Edinburgh. Only serving on one committee now – I&C but about to serve as Diocesan Vocations Adviser. Blogging seems to keep the attention-seeking actress in me amused some of the time but I have learned that it is not always wise to blog everything. Looking forward to living on my own some time soon (one son moves in as the other moves out, and so on and so on).  Hobbies: knitting prayer shawls; reading my Kindle; blogging.

So there we have it. Looking back it seems as if there is no clue to what the next seven years will find me doing. I seem to leap from one thing to the other, changing opinions willy-nilly as I go. Ah, ever fickle and flighty. So where will I be in 7 years, I wonder?

Pooh sticks

Last week Son #2 and I went for a walk. (Yes, you heard me right – a walk.) Well it was a bit of a hike for me and a gentle stroll for him but we got some fresh air so that’s fine.

At one point, going round Callender Park, we came across a wee bridge.

“We could play Pooh Sticks here,” says I.

“Pooh Sticks?” says he.

“Yes, you know. Didn’t we play them when you were wee?”

“Well I played Pooh Sticks, but what do you mean by Pooh Sticks?”

“You know, you throw a stick over one side of the bridge and then race to the other to see whose stick comes out first.”

“Ah. When I was young Pooh Sticks was a whole different thing. You got a stick, you got some dog’s poo on it and you chased folk. Now that’s Pooh Sticks.”

That’s my boy!

Greeting St Joseph and all dads

Today is St Joseph’s day and we prayed for all fathers this morning.

Got me thinking about my own dad. Not a teach-your-child-carpentry kind of dad. Carpentry or DIY was not one of dad’s gifts. But he did teach me how to do the cryptic crossword in the Scotsman and was even known to phone at 7am to ask if I’d finished it and did I know what 3 Down was. He also taught me how to hold my drink, which was terribly important in my hedonistic youth. He taught me the importance of good communication in business and how to mix with people from all sorts of backgrounds. He passed on his ear for music and his wide feet and curly hair.

Now that he has vascular dementia he teaches me patience. He teaches me the Sacrament of the Present Moment. For when I visit now, there is no exuberant conversation from him, no jokes, no plans for the future – just silence. No chats, no questions, no enquiries on how we’re doing, no news from the rest of the family. Of course I can ask those questions but there is really no point for he can’t remember and gets a bit anxious. So it is all a bit one-sided as I tell him what we’ve been up to, give him all our news and then we sit back in companiable silence. We enjoy each other’s presence and enjoy that moment. We have a smoke and we watch whatever is on the loud TV in the smoking lounge. Sometimes I pick up his Scotsman and we have a go at the crossword. Sometimes he even gets the answers to the clues for the cryptic part of his brain still seems to work. But mostly we just sit.

One great thing about growing old is that nothing is going to lead to anything. Everything is of the moment.

Joseph Campbell


Homelessness Sunday – a true story

(This is the story I shall tell tonight at our ecumenical service remembering all Homeless people.)

I want to tell you a story.  A true story.  I used to work for The Rock Trust in Edinburgh who work with young homeless people.  This is a story of one person who was homeless, not a young person, but a person whose story I thought you might be able to relate to. It is the story of Rita.

Rita is a single parent of two children.  She never had much money and didn’t want to go to DHSS for handouts.  She wanted to work.  So she did lots of different jobs while her children were growing up.  She was a barmaid, she did some temping, she sold Avon and Tupperware and Waterless cooking pans. But she always struggled to make ends meet. She got no help from her ex-husband who had mental health problems.

Rita was quite artistic and when her brother-in-law asked her to come and work for him doing some signwriting, she quickly agreed. Being in the family, he would be understanding about time off when kids are sick or on holiday.  For a couple of years she worked in his shop-fitting company doing all the signs for the shops. It wasn’t exactly what she’d planned for herself when she left school, but beggars can’t be choosers.  She learned to use a special computer which cut out self-adhesive letters to stick on windows and vehicles.  Business did quite well.  Well, that’s what she thought.  But then, suddenly, the business went bust and Rita was made redundant.  Her side of the business was doing really well but the shopfitting side was not making money and had to close.

Rita decided to start up on her own.  She put together a business plan and went to the bank to borrow money.  She leased the expensive computer and other equipment and carried on working hard.  Harder than ever.  She did signs for Jenners and for Arnold Clark and Standard Life and lots of small businesses.  She worked seven days a week, doing the accounts and making the signs and fitting them.  It wasn’t easy for Rita but she figured the benefits outweighed the drawbacks.  She wasn’t making much money – just enough to live on in the early days – but she had a wee office that her boys could come to after school and not be latch-key kids.

But then Rita got religion!  She had never been to church before but she just had a feeling that there was more to life than this.  She joined her local church and quickly became very involved.  She was soon on the coffee rota, then reading, then serving at the altar, and taking the youth group.  The more she learned, the more she wanted to learn.  She did a course for adults called Deepening Discipleship and still she wanted to learn more.  But the more she learned, the more dissatisfied she became with her life.  Because her life was made up of days spent thinking about money.  From the minute she opened her eyes in the morning, to the moment she fell asleep, she worried about money.  Would she get paid for that job to get the materials she needed for the next job?  And if you’ve ever been self-employed, you’ll know how hard it is.  Not that she was frightened of hard work, but it was just so money oriented.  So she decided to give up her business.

Rita’s children were older then – one was away from home and the other was just about to do their Standard Grades.  And she told one of her customers, Jane, who had become a friend what she was thinking.  Jane  offered to buy her out.  She knew it was a good going business and she had some contacts too which would bring in more business.  It seemed like an answer to a prayer.  But Jane couldn’t afford to hand over a large sum of money and offered to pay Rita over three years which seemed like a good solution.  Rita would get a monthly amount which would be enough to live on until she found another job.

So Rita handed over the keys and all the equipment and stepped out into the unknown.  She didn’t know what she was going to do, but she did know that God was surely calling her to do something ‘worthwhile’ with her life.  Something that wasn’t all about getting money.  Something that was serving God.  So she did some voluntary work for a charity while she looked around for a job.  And within a few months the charity asked if she’d like to work for them full time.  It wasn’t much money but it did seem to be the answer to her dreams.  She was actually doing some good with her life.

But just as things were looking up for Rita, something happened which would change her life.  Jane stopped making the payments.  First there were excuses that the business wasn’t going well, or Jane was ill.  And then Jane stopped answering the phone.  From the thousands of pounds that Jane was owe her, Rita had only got a couple of hundred. And Jane disappeared.

Of course, Rita went to a lawyer and over the next year she tried to track down Jane to get her money.  The job with the charity gave her just enough to live on, but the extra was needed to pay off the big bank loan she had taken out to start the business.  But Jane was nowhere to be found and rumours were that she had gone to live abroad, leaving a pile of debts behind her.  Debts that Rita was now liable for because of course they hadn’t done the sale of the business between lawyers – it was all done with a handshake and trust.

After a year, Rita got a letter from the bank to say that she was to leave her house within seven days.  They had foreclosed on the loan and as the house was the collateral it was being seized.  Seven days to find a new place, to box up all your belongings, to tell your friends (not to mention the gas and electricity and phone people) where you were moving.  Rita was so ashamed.  So hurt, so let down, so angry.  The flat was all she had, the only security she had managed to hold onto over all those years of working hard for her kids.  And it was to be taken away from her within seven days.  Was this really what God had wanted from her?

The Housing Department weren’t much help.  They didn’t have any flats for rent and it looked like it would have to be B&B accommodation.  But they did say that they would take all her furniture and belongings and put them in storage until she had a permanent place.  It was a dreadful week for Rita.  Phoning the utility services to tell them she was moving but didn’t know where.  Going to work during the day, too ashamed to tell them what had happened, and packing in the evening.  And on the last day the Housing Department came up with Emergency Accommodation in Niddrie, the less salubrious part of Edinburgh.

A flat in a block amidst wasteland and burned out empty blocks.  A flat miles from a bus stop where junkies plied their trade and prostitutes walked the empty roads and youngsters drank Buckfast and spat.

Rita was told the only thing they were allowed to take were some clothes.  No TV, no Radio, no phone, no visitors.  The flat was furnished with everything they would need.  The rest was to go in storage.  They would have one key and the warden could enter the flat at any time of the day or night to check it was not being trashed.  Rita had no time to tell friends where she was living – no mobile phones back in 1995.

Rita says that on that first night when all she could hear were police sirens amid the silence, she really didn’t know how to pray to God.  Her child wasn’t speaking to her and had gone off to their room in a huff, frightened but not admitting it.  Was this really God’s plan for her?  My God, my God, why have you forsaken me?

She was homeless.  She who had worked all her life.  She who went to a ‘good’ school.  She who went to church and helped others.  She wasn’t a drunk or an alcoholic or a lazy good-for-nothing.  She didn’t have mental health problems or any disabilities.  But there she was – homeless all the same.  It really can happen to anyone.

To the person who sits next to you in church, praying fervently.  To the person who works beside you.  To the well dressed woman on the bus sitting beside you.  To the person who turns up on parent’s night and tries to explain why their children are not doing so well this term.  To the person who you thought was your friend but who’s going to visit Niddrie and leave their nice new car parked in that wasteland?

Rita’s story goes on but you don’t need to hear the rest.  I really just wanted to tell you Rita’s story so that you could see that homelessness could happen to anyone.  To you or to me.  And it did happen to me, because in case you haven’t guessed – Rita is really me.  We did eventually get a flat in a horrible scheme in the south of Edinburgh.  I carried on doing my studies at New College and was accepted to do the BD.  I worked part time with The Rock Trust while I was studying and I was accepted to train for the priesthood.

Was it all God’s plan?  Who knows?  I don’t think God deliberately makes people homeless but I do know now that God was with me through it all.  And God was in the woman in the Housing Department who found me the flat and didn’t put us into B&B.  And God was in the Warden of the Emergency Accommodation who turned a blind eye when friends came to call.  And God was in the most beautiful sky-scape on the first night in our new flat high up in Gilmerton when pink ribbons wound their way across the sky from the Pentlands to Arthur’s Seat.  God was in the mess and in the people we met and on the day I graduated and was then ordained.  God was in it all.

Thank God.

Death and assisted dying

Death is all around me at the moment. It is in our daily readings in the Offices. It is in the tears of the recently bereaved who read them with me. It is in the watching and waiting as a beloved mother dies. It is in the memories of those who find this time of year difficult because of an anniversary or the first Christmas without them. It is in the oil to anoint a chilled brow. It is in the bleak chill of the cemetary that I can’t reach. Death is all around.

This morning I have been thinking about how to achieve a happy death. We can’t all choose that we will have a happy death. And if we were just to spend some time thinking about how that might be, what would you want? At the end of a good and satisfying life, in peaceful surroundings, with no pain? That is an ideal that not many can achieve. But when it does we can give thanks.

Reading James Woodward’s blog this morning has made me think about my mum’s death. It was not a happy death. It was in a hospice which should have meant that all was done to make it a ‘good death’. That didn’t happen. On her first visit (to get medication sorted) a nurse was impatient with her when she needed the toilet. To mum she seemed brusque and impatient and made her wait for a long time in desperation. She was rude and she shouted at mum. Of course we don’t know what was going on elsewhere in the ward at that time, and why that particular nurse seemed uncaring. Nor would they know that when my mum needed ‘to go’ there was no hanging about. But somehow this episode became a huge issue for mum. It may be that it became the focus for all her fears about dying, but nobody ever took time to listen to her to find out. She couldn’t wait to get home.

She did get home after a few days to stay with my sister. There she was cared for day and night by C with visiting health care workers coming in daily who got to know her well and who listened. She wanted to die there. She was adamant that she didn’t want to go back to that hospice. But then she collapsed and my sister couldn’t get her up off the floor. For that, and other reasons, the decision was made that she should go into the hospice. I was part of that decision and we all felt it was for the best. I went in the ambulance with mum and it was then that she turned her face to the wall. She didn’t want to go and made it clear that she was unhappy. So unhappy, in fact, that she didn’t speak again for a week until she died. We visited daily and tried to chivvy her along but she remained facing the wall (literally, as her bed was against a wall). The doctors said she was suffering from depression and they would give her medication for that but that it would take time to work. Time she didn’t have.

For weeks before she had been asking to die. She begged doctors and health visitors to give her something to speed the process. She wasn’t in pain but she knew that it was only a matter of time and she didn’t want to prolong it, for her sake and ours. She knew that daily visiting and caring was taking its toll on us all. (We didn’t mind, of course, but we knew she did. She never wanted to be a burden.) In the hospice we knew she only had days to live and when she wouldn’t speak to us, we were told that the only thing she said to doctors was that she wanted to die. There was nothing they could do. She has signed a Living Will but in these circumstances it wasn’t much good.

Nearly five years later I can still remember that last week clearly. It was not a happy death. It was a smelly, silent, and prolonged death. The hospice didn’t burden us with the information that her wound was infected and that she probably had MRSA or some other infection. We only knew when the ward was closed after her death and her belongings destroyed.

And we are left with the knowledge that it needn’t have been like that. I believe mum could have had a happy death. She could have had a happy death at home if the correct care was in place to help people care for their relatives there. And this appears to be a postcode lottery as I hear and have seen Macmillan nurses doing all they can to create such an atmosphere, but they are not available everywhere. She could have had a happy death if a nurse had been more sympathetic over something as basic as bringing a commode sooner. She could have had a happy death if a doctor had been willing to give her something which would have allowed her to bring her death forward by a few days.

I’ve heard speakers from the Church resist assisted dying. I don’t understand it. We know and believe they are going to a better place. I visited someone two days ago who was allowed home from hospital to die. It was peaceful, quiet, spiritual, warm and, in the end, a happy death. It is something that I pray for without fail – that we should all have such a happy death.

Spamalot

Gosh, I’ve just noticed that I really haven’t been blogging much lately. I put it down to a new job and much scurrying hither and thither. However on my day off I did head east to Auld Reekie for a little retail therapy (with gift tokens – the best kind!), visited my sister and then met Son #2 for a meal.  Then we went to see Spamalot at the Playhouse. Now this wasn’t my choice but what Son #2 had asked for his birthday earlier in the month. I mean, I did like Monty Pythons in their day but I’m not what you’d call a huge fan now. So, I wasn’t particularly looking forward to it. But what a surprise. It was hilarious and camp and just what I needed.  (Mind you, the 2nd half was even better when we moved seat and I wasn’t sitting behind the 6’4″ gentleman with Leo Sayer hair.)

The star of the show was Marcus Brigstocke as Arthur with Todd Carty as Patsy. The old jokes were there along with a few new and topical ones. The audience joined in with gusto and were clearly old fans who knew what was coming up.  All in all, a great night out and highly recommended.  (Son #2 laughed like a drain throughout.)

Total Solar Eclipse 2010

Son #1 and girlfriend and friend have been on Easter Island for the past few weeks at a festival to celebrate the Total Solar Eclipse. I’m told the festival was a bit of a disaster – no drinking water, few bands as advertised but just rave music,  etc – but it looks as if they had fun all the same.

Here is the link to what they did. Son #1 doesn’t feature much because he seems to have been videoing it so I won’t tell you which one to look for. Just enjoy the music and watch some hippies dancing and the sun disappearing.

See full size image

Grandparents

Icon of Sts. Joachim and Anna.......Click to EnterToday is the Feast of Anna and Joachim, Jesus’ grandparents. So today I have been thinking of my grandparents.

My dad’s parents came from Polmont, near Falkirk. Grandpa was a head teacher at the Wellington School just outside Penicuik and that was where my dad was brought up – in a Borstel.  He died when I was about 3 or 4 so I don’t have many memories of him – except one, when I remember sitting on his knee beside the fire in their retirement house in Morningside being taught that if you mixed red and blue paint you got purple. Grandma brings many more memories. She lived until Son #2 was a baby when she died in a fire (on the same day as Gracie Fields who she detested, btw, but Grandma got higher billing on the front page of the Evening News!) She was a poppet, a gentle soul who loved everyone and never had a bad word on any subject, except Catholics bizarrely enough but I suspect that was due to her upbringing. I remember caramel wafers and other ‘wrapped’ chocolate biscuits which was a treat for us poor souls. At Christmas she always had a box of Sobranie cocktail and rainbow cigarettes on the table, brought back from one of her sons who lived in Kuwait. ( In my teenage years, I was known to abscond with them.) She moved to Newington to live in a flat below my dad (in a house that had belonged to Moira Shearer of The Red Shoes fame) and gradually became more bewildered. I loved visiting her because she had lovely paintings and looked after us well. There was talk of her going into a nursing home when she started locking herself out and leaving pots to burn dry, but she died before that happened, trying to put out her electric blanket fire herself. Today I give thanks for her sense of fun, of giving, of loving, of charm.

My mum’s parents lived in Penicuik in the mill house at Eskbridge. My grandad died when I was 5 so again I don’t have many memories of him except being dragged round their garden in a cardboard box – oh, we knew how to have fun in those days! I also remember sitting next to him in the stick house in front of a large zinc bath plucking chickens. He was shy, gentle and kind. My granny, on the other hand, was a scary person. She never really liked me, or so I felt, because I was very like my dad and she never forgave him for divorcing my mum when I was five. We had to visit her every single Saturday in life – rain, sunshine or snow. I remember walking down the brae with snow up to my knees on some occasions. When we were very young she worked as a nanny to the Cowan children who were an important family in Penicuik and we got to go with her sometimes. Then she moved to John Street and we kept on visiting. Picking fault at make-up, clothes and hair seemed to be her favourite pastimes to me. Put it this way, she did nothing for my self-esteem! Other memories include knitting, a stuffed pheasant, wrestling on the TV with Big Daddy, trips to Peebles, church with pandrops and fur coats, great lentil soup and mince and tatties. And when she visited us it involved days of cleaning and tidying and she still could run a white gloved finger along a surface and find dust. I can’t remember what she died of but she lived to a good old age.

Today I give thanks for all of them. For their teaching and affirmations and love and fun. And perhaps for the lesson that I would never force my children to visit me.

Hospital Success Story

Readers may remember that some time ago I had cause to complain to the local hospital after my father was admitted with a suspected heart attack.  Hygiene, lack of ‘old fashioned’ nursing, and other issues were raised.  The Patient Liaison Manager did get in touch and offered to meet with me to discuss the matter and that meeting was today. I met with a manager from A&E and Combined Assessment of Lothian hospitals, someone high up in A&E or Nursing, and someone from Patient Liaison.

I just want to let you know that the meeting was a great success. All the issues had been addressed and I was pleased that they had taken it all so seriously.  A&E staff are even getting further training in working with people who have dementia.  No excuses were given – just hands held up and apologies made that they are trying to make sure it doesn’t happen again.  The grotty floor has even been replaced!

They also stressed that they were pleased to get my letter and to meet and discuss it too.  It had allowed staff to see how they were perceived by patients and relatives and I was told they were horrified.

So, to those who said I shouldn’t have written and that I was a thoughtless daughter, can I merely say that the hospital did not feel the same. In future if you have any concerns you should speak to the Duty Care Manager at the time or write to Patient Liaison as I did. They are always looking at ways to improve.