Care in the UK – 5 years on – Part 4

The next days were spent making arrangements for your funeral. 

I began to follow up some of the questions I’d already asked in mid-December 2007 of the Mental Health Care of Older People Team, part of Camden and Islington NHS / Mental Health and Social Care Trust.  Their social worker wrote to me the day before the funeral to inform me that she’d no longer be the allocated worker, but that her Deputy Manager would be coordinating the “on-going enquiry” into the circumstances leading to your admission to hospital. There was to be a comprehensive investigation under their Adult Protection Procedures.  I asked to be allowed to attend all meetings and to receive a copy of the Report of the Investigation.  The Deputy Manager of the MHCOP team said she didn’t envisage any problems with that request; she knew by then that I’d want and need to stay fully involved.

I’d contacted CSCI (now the CQC) on 20 December 2007, while you were still alive,  to tell them of my concerns about your care, or rather lack of it.  It took them a while to find the right department dealing with Lennox House.  CSCI had not been notified of your sudden admission to hospital on 8 December 2007,  so the inspector I spoke to said they would write to the manager of Lennox House and to me.  I heard nothing back from CSCI, so I phoned them again on 21 January 2008,  to be told that CSCI had indeed written to the manager after my phone call and that they’d received a call back from her to say that she would reply in due course. 

But CSCI  received no response from her, so they contacted her again on 21 January 2008.  That’s when I first discovered that the manager told CSCI, that very day,  that she had ‘arranged’ a meeting with me on 31 December 2007 (as I mentioned here) and that all my ‘concerns had been ironed out’ at that so-called meeting.  That is far from the truth.

Your social worker had a few busy days too, round about 20/21.12.2007, and when I received a copy of your notes (much later in February 2008) I was able to know more.  According to the notes, she’d apparently tried to phone me so many times but had never been able to reach me or to leave a message for me.  Strangely enough, many other people had managed to do just that.  I knew nothing of Adult Protection Procedures or the ‘Form AP2’ that was completed then.  Islington’s Adult Protection Coordinator was busy too, but I did manage to speak with her just the once. 

When I received your notes, sent to me on 12 February 2008, I read that the Adult Protection Coordinator had advised your social worker on 2 January 2008 – well before the funeral – that your family had the right “to request an inquest, though MHCOP would not do this”.    (They are the exact words used in the social worker’s notes.)

Why is it, do you think, that absolutely nobody at all cared enough to pass that vital piece of information to your family?  Not one person told us that we had the right “to request an inquest, though MHCOP would not do this”.  

MHCOP (Mental Health Care of Older People) were well aware that there were serious concerns about the lack of care provided to you by Care UK’s so-called care home Lennox House. 

But nobody cared enough about you or your family to tell us that we had that basic human right.  There were a few other things noted that they could have transmitted to your family too, but nobody cared enough to tell us.  In the best interests of whom was that decision made to withhold vital information from us?

According to the notes, MCHOP were faffing around trying to work out whether there was anybody available in MHCOP with the ‘capacity to conduct an investigation’.  Not wishing to be facetious, but I do wonder whether they meant the ‘mental capacity’ or the ‘physical capacity’ to conduct an investigation.  In the event, an Independent Nurse Consultant was commissioned by MHCOP to carry out the investigation and to write a Report.

The social worker signed off on 8 January 2008 and departed by writing that she would no longer be involved in your case as “the only remaining work is the completion of the POVA enquiry”.  POVA was the Protection of Vulnerable Adults.

You deserved better care.

(To be continued)

 

 

Care in the UK – 5 years on – Part 3

This day five years ago, 31 December 2007, was a difficult one for many reasons.  I know that you won’t wish me to go into the detail of some of those reasons here.

We drove to London again and spent 4 hours at the Whittington Hospital dealing with various formalities. Most of the morning we spent in the PALS office (Patient Advice and Liaison Service) and talking on the phone with the Coroner’s Office and with one of the hospital doctors involved in your care.  We grabbed a coffee and  left at about 1 o’clock, having decided that we did not want to have to return to that part of London again in the near future.

That’s why we went – on the spur of the moment, unplanned and unannounced – to Lennox House to collect your belongings and avoid the need to go back there again.  While you were still alive, just, I’d already asked the manager to send me a copy of everything on your records.   On 20 December 2007 I received a copy of a document that Care UK calls the ‘Daily Record’ .  It was only 9 pages so I asked the manager to copy and send everything else.  It was the only document I’d seen then, but it gave a good indication of the very days when you must have been desperate for help, but no indication of any help being given.

We parked the car and were able to walk straight into Lennox House.  So much for security.  The manager was at reception, but she didn’t recognise us.  She’d only met us once before,  back in August 2007 when we went on a recce to Lennox House, just one of the care homes we looked at.  There was no reason she should have recognised us.  I introduced myself and explained that we’d come to collect your belongings.  She said she’d just been speaking with your niece on the phone and she was planning to collect your things.  It was easier for us to do it there and then, as that niece doesn’t drive.  She also said that she was just writing a note to me, to accompany the paperwork I had asked for.  I said I’d take it all with me and save her the trouble of posting it.

We went to your room, and packed your things; a few were missing, especially two rings.  I asked for them – but I was assured you had not had any rings on your fingers when you arrived in Lennox House.  It was an uncomfortable thing to hear, because we ‘d bought one of those rings, the ruby ring, for your 80th birthday.  The sapphire and diamond ring had been on your finger for the last 60 years –  more years than I care to remember.  I’d noticed you were wearing both rings when we last saw you there, in November.  Eventually, the staff managed to come up with one of the rings.  The other one never surfaced.

We went down to reception.  I was asked to go into the manager’s office, while “His Lordship” as you always called him took your things to the car, before returning.  In that office, I was subjected to an inquisition.  I was expected to go through every single line of the Daily Record and explain my concerns to the manager, as she wrote alterations on the pages.  I thought I’d already done that on the phone earlier in December, but I still had to go through it all again.  It became impossible for me, and I left the office in tears saying I just couldn’t go on with it.  We had spent 4 hours at the Whittington Hospital, and I was exhausted.

I told the manager much of what we’d been through when you were in hospital, including being asked to explain how your diabetes was so out of control.  I’d already spoken with the GP who hadn’t bothered to look at the meds you were taking, when she’d been called to the home, and who told me she was not aware that you were a diabetic.  If she had been given a list of the meds you were taking it would have been obvious to her that you were a diabetic.  If one of the nurses had told the GP you were a diabetic, she might have treated you differently.   (She’d never met you before, as you were new to the care home and new to the surgery providing services to that care home.)  Interestingly, it was only from that Daily Record that I discovered the GP had spoken with Lennox House (on 14 December 2007, while you were in hospital) before she returned my call to her that day.

The manager told me that there were no available glucose strips in that home,  because the GP does not prescribe them.  The manager told me that Care UK wouldn’t provide them either.  To say that I was shocked, again, would be an understatement.  I volunteered to pay for a year’s supply so that no other person with diabetes would ever arrive in A&E in a diabetic coma, like you did.  With much of your bloods and tests ‘deranged’ .

I’m still trying to work out why those same words about glucose strips being unavailable are written in your care home notes, in the Daily Record for 7 December 2007.  It’s such a strange few lines to have been added to someone’s personal care record.  After all, you weren’t the only resident with diabetes, so  it strikes me as a very strange addition to your records.  Contemporaneous?  I doubt it.

The manager said “we have taken steps to make sure this never happens again”.

That was too late for you.  You only had one chance.

What I didn’t know until much later (namely July 2008)  was that a ‘Complaints Form’ came into being on this day, five years ago.  Its purpose was to indicate that ‘a meeting had been arranged’ to discuss my concerns, all of which appear to have been resolved that very day.  I learned from CSCI (Commission for Social Care Inspection) that a ‘meeting had been arranged’ this day, 5 years ago, to discuss my concerns.   It must be the first ‘meeting’ where people stood to ‘discuss’, rather than sat comfortably.   CSCI asked for a copy of the minutes of that meeting.  CSCI is now the CQC (Care Quality Commission).  There were no minutes – because it was not a meeting.  It was a chance encounter.   (More about this all another time.)

I left Lennox House in tears.  This day 5 years ago.

You deserved better care.

(To be continued)

Another personal message to The Horse

It’s strange to see you keep returning to my Blog. You have not the slightest interest in the content, in me or in the background to my Blog. I can only imagine what you’re hoping to find.  When you first started stalking me here, you wondered whether you should be concerned.  They were your words – not mine.

I’m not the only person you’re stalking.  You are becoming a bully.  A bully with a need to control every single thing in its path, from the individual words people choose to use to the wider way they choose to express themselves.  You work hard to entice ponies resembling sheep into your stable, so your stud is now somewhat mixed, sad and confused.  You are rude, patronising and arrogant.  You are brutal.  You are a dictator.  That is dangerous.

Treatment is available for mental health problems.  Perhaps you are in the wrong place; the place you spend your every waking hour is adding to your problems.  You can’t even see that people are laughing at you now; they are not laughing with you.

Stalking is a specific criminal offence in the UK.

“Greater Manchester Police Assistant Chief Constable Garry Shewan, who leads on stalking and harassment for the Association of Chief Police Officers (ACPO), said the law change would make it easier for victims to go to the police.”  “Stalking was previously dealt with under harassment laws introduced in 1997. He said the field had changed, including the emergence of cyber-stalking, and it was right the law was adapted to ‘plug any gaps’.”  Read more here. 

You should take great care to retreat into the background, rather than keeping your own ego puffed up by belittling people.  You have the power of position that allows you to be as sarcastic and rude to people as you wish.  Your position allows you to humiliate people.  They have no chance of returning your criticism, not even in a more polite way than your own method.

You think you are beyond reproach, because you hold the whip in your hand.

You are the self-appointed judge, jury, prison officer, executioner.

You hold the keys to the cells and you use them whenever it is in your own best interests.

How sad is that?

Shame on you.  Yes, you should be concerned.

Nadine Dorries & her super-inflated ego

I haven’t been bothered to keep up with Nadine Dorries and her antics until now.  Partly because I don’t often watch that programme.

I’ve heard the rubbish that she has occasionally spouted, and I’ve read the rubbish she’s reported as having spouted.

All I can say is Get Her Out of Here.

She appears to me to be just another self-centred, fame-seeking, super-inflated egotistical mind-numbingly boring person who does not deserve to be supported by the Public Purse.

 

Why I despise the so-called system of care for vulnerable people

I’ve been fairly controlled over recent weeks, months or even years.  I suppose I’ve been waiting and hoping for a chink of light to emerge, for a culture change to emerge, for a way forward to emerge in the so-called system of care that we have allowed to be in place.

However, I am reaching screaming point.  Hardly surprising.  When someone is destroyed because of absent systems of protection, and when it then takes almost 5 years to work your way through to a full understanding of why the so-callled system of care for vulnerable people fails to provide decent care so very often – that’s when you reach screaming point.

Time and time again, the CQC comes up with yet another report as it did today, with a report into the ‘care’ afforded to people with learning disabilities.  Or rather the lack of  care.  I’ve read it all, but there’s not much hope for real change.

Week and month after week and month, our government comes up with …… not one single plan to improve things.

Year after year, the same old same old same old gets published in the press, reported on radio, featured on TV.

Still nothing changes, so I need to scream now.  It won’t change anything – but it may just help me to scream.

[Next section of this particular blog post: Deleted temporarily pending the return of sense to the world of care.]

Therewith, I will leave this one for today.  But not for long.

To care or not to care?

Imagine the 83-year old person in the following story was your own relative.

The article is here : Islington Gazette – dated 10 February 2012 – a few extracts below:

‘The Nursing and Midwifery Council’s (NMC) Conduct and Competence Panel is investigating five nurses’ care and treatment of an 83-year-old woman who died after spending around 10 days 
at Lennox House Nursing Home in Durham Road, Islington.

The panel heard this week that the elderly woman was taken to Accident and Emergency at Whittington Hospital in a diabetic coma on December 8, 2007. She died on December 27.

It is alleged that several serious signs of deterioration in the two days leading up to her hospital admission weren’t acted on.

These included agitation and a tendency to lay on the floor – symptoms which retired nurse Sue Bradell-Smith, who carried out the investigation of Lennox House in 2008, said were abnormal and would have made her “very worried”.

Other allegations include a failure to monitor the patient’s condition and diabetes, failing to create a pain management plan and feeding the patient fluids orally although her swallowing difficulties were known.

According to the home’s records, by the evening of December 8 she was suffering with continuous muscle spasms and had dysphasia, an inability to speak – yet it is claimed that the emergency services weren’t called straight away.

NMC’s solicitor John Lucarotti said the treatment provided fell far below what is expected of a nurse.’

How would you feel if you are now being required to understand alleged facts that are totally new to you – almost four-and-a-half years after the death of your relative?

You are now being given to understand that the care home manager was in the building all day long, right through from 8.30 am to 8 pm in the evening – but couldn’t be bothered to get off her backside to attend to one 83- year old in desperate need of care and attention.

You are now being given to understand that a nurse came to see the manager and told her that the 83-year old was not well.  Still the manager did nothing.

You are now being given to understand that nobody involved considers that the care they provided was poor.

You are now being given to understand that the manager didn’t react or even care much when the nurse told her the 83-year old was in spasm, unable to speak, unable to swallow.

Can you imagine how you would be feeling now?

 

Registered nurses working as Healthcare Assistants (HCAs)

The NMC (Nursing and Midwifery Council) website contains valuable information for those with an interest in the established fact that many registered nurses (and/or midwives) are working as HCAs (Healthcare Assistants).  The nursing profession is regulated by the NMC.  Healthcare Assistants are not regulated at all.  Problems  emerge when a Registered Nurse is employed by a care provider as a Healthcare Assistant but works outside of that role and still fails to provide the care required of a registered nurse.

A couple of direct quotes from the NMC are essential.  The full text of the NMC information is available .

First quote (my use of red below, not that of the NMC) :

Accountability

If a nurse or midwife is employed to fulfil the role of an HCA, they should only undertake the roles and duties outlined within their job description. However, by virtue of their registration, they would remain accountable for their practice. This means that they would be bound by the code regardless of their HCA status and their fitness to practise could be called into question if they were found to be in breach of any of the terms. The code states that nurses and midwives are required to “provide a high standard of practice and care at all times”

The code states:

“you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions”

“you must be able to demonstrate that you have acted in someone’s best interests if you have provided care in an emergency”

Therefore, in an emergency situation, there may be occasions, where a nurse or midwife could be required to work outside the scope of the HCA role parameters. As a registered nurse or midwife they would be expected to use their professional knowledge, judgement and skills to determine occasions where it would be appropriate to work outside their HCA role parameters and should be prepared to account for their actions should they make the decision to do so.

Second quote:

Vicarious liability

Vicarious liability means that the employer is accountable for the standard of care delivered and is responsible for employees working within agreed limits of competence appropriate to the abilities of that employee. To remain covered by an employer’s vicarious liability clause, an employee must only work within this area of assessed competence and within the responsibilities of their role and job description.

Nurses or midwives who undertake HCA roles should therefore, inform their employer that they are on the NMC register as a nurse or midwife and that in exercising their professional accountability, they may be required to step outside their contract of employment as an HCA. They should also seek to ensure that their contract recognises the extent of their role and that the job description is clear as to what would be expected of them in this role.

End of quotes.

It’s well-known that HCAs are not regulated.  A system of voluntary registration will not be good enough.

Dr Peter Carter, head of the RCN (Royal College of Nursing), said recently that the NHS is too reliant on  HCAs who are asked to pick up nursing skills as they go along.  Untrained, unregulated, cheap labour.

“Many hospitals employ healthcare assistants as opposed to registered nurses, and many of them don’t give them as much as an hour’s training.

“This happens in some care homes and domiciliary care too.”

“It is wholly unacceptable that the elderly should be cared for by people who are not given the rudimentary training.”

He also said “Cheap care is poor care.  Poor care ends up being more expensive.”

The RCN refers to itself as ‘the voice of nursing across the UK and the largest professional union of nursing staff in the world with more than 400,000 members’.  It also invites Nurses qualified outside of the UK working as health care assistants, ‘who are not and have never been registered with the Nursing and Midwifery Council (NMC)’,  to join the RCN at a concessionary rate for the first year.

The RCN offers advice to registered nurses and midwives who do not meet NMC requirements, providing information for overseas nurses who cannot register to work as a registered nurse or midwife but who are currently living in the UK.

On 11 January 2012 the Guardian featured an article about ‘Healthcare Assistants working out of their depth’ and mentioned several respondents to a survey conducted by Nursing Standard magazine who said that HCAs monitored patients’ vital signs but did not understand the results.

‘ One nurse in the survey said: “There is sometimes an attitude from unregistered staff that it doesn’t matter what they do because ultimately it is the registered nurse looking after the patient who will take responsibility.’

Are some care home providers in the UK employing NMC Registered Nurses ‘on the cheap’ by contracting them to work as HCAs and thus by-passing regulatory requirements?  Are some care home providers in the UK doing so because they are fully aware that the registered nurse is not ‘fit for purpose’ as a nurse?  Are some care home providers in the UK employing staff  as HCAs but still allowing them to perform the functions of a registered nurse even though the care provider is aware of the inadequacy of the registered nurse in question?

Vulnerable care home residents are placed at risk.

“Cheap care is poor care.  Poor care ends up being more expensive.”

NMC hearings schedules – aka close to Care in the UK

I omitted to post this :  NMC Hearings Schedule – 6th to 17th February 2012 – at Euston House, London.

All in the best interests of Care in the UK.

More later, but click here for the charges.  Same as above link – but I wouldn’t want anyone to miss it.

Thou shalt not grow old – IF says so!

I was just about to settle down with a nice cup of tea to watch a bunch of old codgers wend their way, line by line, paragraph by paragraph, section by section, through the Health & Social Care Bill.  It’s Day One of the Committee Stage in the House of Lords.  But I arrived at Parliament TV too early, so with time on my hands, I thought I’d have a blog about.

Before the kettle had boiled, I came across Outside Left’s cheeky little piece about another bunch of old codgers, this time those on the receiving end of the doubtful wisdom of the Intergenerational Foundation.    (Whoever thought up that name needs help!)  ‘The Intergenerational Foundation (IF) is a newly established non-party-­political charity that seeks to promote the rights of younger and future generations in British policy-making.’ (It’s not often you see the words ‘political’ and ‘charity’ come together in one sentence.  Very strange bedfellows – or perhaps that should be spare-bedroom fellows.)

‘The ability of groups in their late twenties and early thirties to ‘settle down’ and have children is running into the physical obstacle of the lack of housing space.’ according to IF.  ‘There are now over 25 million empty bedrooms in under-occupied homes in England – rooms that are surplus to need based on the English Housing Standard. Very many of these are in the homes of the
retired, and by 2026 empty bedrooms in the homes of the retired will exceed 10 million.’

Well, you could knock me down with a feather!  It’s all the fault of the retired older generation with a spare bedroom or two.  Henceforth should they be known as ‘house hoarders’.

‘The rights of younger and future generations.’  Sod the rights of the current older generation!  That section of the Great British public who will remember WWII, ration books, make-do-and-mend, hand-me-downs, cutting up a cardboard box to make  inner soles to fit in shoes with holes in their soles, the outside toilet, a bath once-a-week, no showers, no central heating, no fridges, corporal punishment, toys and presents at birthdays and the midwinter festival only, life before the washing machine and the supermarket, and life with 15% mortgage interest rates or higher.   ….. …… And yet, they’d never had it so good!

Harold Macmillan, PM:  “What we need is restraint and commonsense – restraint in the demands we make and commonsense on how we spend our income.”  So along came the wage freeze, tower blocks to solve the housing shortage created by that damned war and the increasing population, a man was sent into orbit in space, and later men walked on the moon.  A collection of geeks invented things like video tape recorders and computers. Along came the Beetles, Mods and Rockers, drainpipes, winkle pickers.  More men walked on the moon!

It’s estimated that it took 3 hours of work time in the mid-1950s to pay for a weekly basket of basic food items such as milk, butter and bread.  Fifty years later, when all the emerging house-hoarders were showing signs of clinging onto their spare bedrooms, it took a mere 40 minutes work time to buy a similar weekly basket of food.

(The old codgers in the House of Lords have long since begun their deliberations, and I’m using it as radio. They’re not that photogenic, but they do sound good.  They use a few good words to describe the Bill – ‘unspeakably awful’ and ‘wilful disregard’ might sum it up.  If only they’d thrown it out!!)

Meanwhile, back at the Intergenerational Foundation:  ‘The British ‘family home’ is increasingly not owned by families, but by older, post-reproductive couples and single people.’   The reason given for the lifecycle of housing breakdown is the ‘behaviour of older groups’.

Post-reproductive!!  Just let the IF try to use the word post-productive – they really will meet the full g-force of the ‘behaviour of older groups’.

Tut-tut!  Their behaviour gets worse – it’s even been known for older people to move into larger houses well after their chicks have flown off to their own nests.  They are also to be found guilty of  ‘over-consumption’.

A sideways glance brought my tea-deprived self back to yesterday’s revelation that the people charged following the riots in August in various parts of the country were in fact ‘poorer, younger and of lower educational achievement than average’ rather than the thugs, scum and vermin that Work and Pensions Secretary Iain Duncan Smith, in particular, would have us believe.  IDS and his fellow MPs used many more foul words to describe these ‘poor, young people of lower educational achievement than average’ – and not many of the words used by our Representatives in the House of Commons were acceptable.

Of the young people involved, 42% were in receipt of free school meals compared to an average of 16%, and two-thirds of young people involved in the riots were found to have had a special educational need (SEN), compared to 21% for the national average

£300 daily allowance is paid to each unsalaried Lord who turns up and sits in the House of Lords.  Our Noble Lords  spent nearly two hours discussing the first amendment, before they voted.  A total of 456 Lords voted on that first amendment.

456 x £300 = £136,800.00.

One amendment down – 399 or more to come!!

The IF may soon write the next Ten Commandments.

Thou shalt not misbehave.

Thou shalt not retire.

Thou shalt not want a spare room so that family and friends might visit
you.

Thou shalt not house-hoard.

Thou shalt not over-consume.

Thou shalt not bedroom-block.

Thou shalt not expect governments to provide sufficient
housing for all.

Thou shalt not expect the younger generation to care about
you.

Thou shalt not develop dementia.

Thou shalt not grow old.

A personal message to The Horse

This is a personal message from me to The Horse.

This particular Horse has no better purpose in their sad little life than to stalk  and to track me.

Morning, noon and night,  The Horse is positioned at the keyboard, trying to focus on the next fence, hoping that it will come towards and within their peripheral vision and then become the centre point of their breathtakingly boring existence.  Panting and puffing, The Horse must know that it’s a waste of their time.

The Horse is an Outsider, all at very long distance, that is, because this particular Horse lives thousands of miles away, but still would profess to know more about life in this once Great Britain of ours than we know ourselves.   The Horse was exported from these shores circa 30 years ago, but still knows more about day-to-day life here than most of us know ourselves!  That takes some doing.  Or it did before the advent of Google.

Now is the time for all good Googles to come to the aid of The Horse.

The Horse’s life is perhaps pointless and empty, so I should be flattered and encourged to know that I am at least giving meaning to a life .

I feel desperately sorry for The Horse –  if only because so desperate is The Horse that others have been enticed to sniff at the nosebag of The Horse, all by virtue of a message sent round from The Horse to the under-horselings.  Or are those others sniffing at The Horse’s droplets in a fashion similar to that of our grandparents as they strove to shovel up and spread  muck around the roses?

The Horse is welcome to any fragrant droplets that fall from my fingertips, here and in all the other places The Horse tracks me to.

Bye bye, Horse.  You have now been put out to grass, out to pasture, out into the wilderness of usefulness.

I hope you will miss me, Horse, as much as I won’t miss you.

All you need to do is to subscribe, Horse, and you will save yourself a huge amount of energy and long-distance broadband usage.  As for all the other places you track and trace, many have already become aware of your interest.  They thank you and your followers for boosting their viewing figures!

I should perhaps add that I am not the only one being stalked by this particular Horse.  For some unfathomable reason, The Horse feeds on dismantling every single word that is written by any one of the apples of this Horse’s eye.  Para by para, line by line, word by word …. that’s what The Horse feeds on.   Straight to The Horse’s mouth!!

I hope you have a good retirement, Horse, and that your under-horselings will soon rid themselves of your uncomfortable influence.

PS added, to comment on recent contacts from The Horse and from The Horse’s underlings who all seem to be jumping to order : 

To answer The Horse’s question, yes, I do think you should be concerned – you should be seriously concerned.   You have compromised your position for years now, much to the amazement and the disgust of others who have no choice but to put up with your astonishing heartlessness – so it is about time you looked long and hard at your motives.  It’s also about time those who pay for your services should also look at their own reasons for keeping you on their pay-roll, even though that pay-roll may be more perks than bucks.  The Horse knows all about bucks, but has forgotten how to care about The Heart.