In loving memory: How the loss of a loved one need not be the end, but a new beginning

• The Duchess of Hamilton, who prefers to be known as Kay, in the garden of the smaller house she moved to with her husband Angus from the Archerfield estate. Picture: Neil Hanna

IN ALMOST all the photographs of them together Angus, the late Duke of Hamilton is pictured with his arm resting tenderly on the shoulder of Kay, his third wife. Theirs was an extraordinary love story - Scotland's leading nobleman, who died aged 71 in June having suffered from Alzheimer's, came to depend utterly on the former nurse from Aberdeen.

This year the Duchess is preparing to spend her first Christmas alone - but she has also embarked on a campaign to change the way Scotland treats people with dementia.

"I think this Christmas is going to be very lonely for me. I'm going to Aberdeen to visit my daughter and I'll see friends I haven't seen for a long time which is nice.

"But happiness and tears, I have discovered, are very close together."

Kay, who will be known as the Duchess of Hamilton until the late Duke's son, Alexander, marries next year, when she will become the Dowager Duchess, still lives in the house in Dirleton where her husband spent his last few months.

Like any recently bereaved person her eyes often brim with tears, but when she talks about her campaign to improve the care of those with dementia she speaks with the quiet but fiery determination of a seasoned campaigner.

She's a warm and thoughtful person - offering the Scotsman photographer and me coffee and cake and asking about our journey through the snow. When I ask if I should call her: "Your Grace", she says: "There's no need for that. We were always just Kay and Angus."

Her home is a warm, lively, comfortable one full of family photographs and pictures of the Staffordshire bull terriers which she and the Duke loved. The couple moved here in October last year, leaving their large seven-bedroom family house on the Archerfield estate to relocate to a more modest four-bedroom home. The Duke helped choose which paintings to bring from Archerfield, now the home of his eldest son.

"I am so glad we lived in this house together.

"People said how can you move when he is ill - but we were always going to move and he loved the view.When we moved he was still able to take part in decisions - the idea was to make the house as safe and practical as possible."

The house is dominated by pictures of Angus, the 15th Duke - standing by a plane, playing the bagpipes, walking with the dogs. Officially the head of the Scottish nobility, and charged with carrying the Scottish crown at state events Angus Hamilton was an unusual aristocrat, as he was a trained engineer, a pilot, and a man who valued practical achievements above ideas of rank.

"He always did his duty. He was proud of the dukedom - but he was always most proud of someone who actually did something. The best compliment he could give to anyone was, 'He is good with his hands.'

"I was told recently that someone said to him, 'I'm not sure how to address a Duke,' and he said, 'I have no idea - I don't really mix with them.'

"He had such good manners. He was a gentleman - but he really loved people.

"That is proved by over 700 letters I got when he died. Not from the great and the good - but from the people whose lives he had touched over the years."

She first met the Duke in the 1980s, when she went to inspect his home to see if it was a suitable place to house a rescue dog.

"That wasn't the right time for us. I still had two children living at home. But we always kept in touch."

In the summer of 1991 his daughter called to say he wasn't well. "I came down to look after him and we just knew that was it.

"We were going to be together from then on. We were never apart after that.

"He was in a bad way - but so was I. We both needed each other. Nobody will ever know how good Angus was to me.

"We went away secretly and married in 1998 - we told no-one - but of course everyone found out."

To Kay becoming a duchess was "never a big deal.

"Angus and I were brought up the same way. If you treat everyone with respect you don't have to worry about things like that."

The Duke joined his wife in her campaigns against animal cruelty. In Christmas 2004 the couple invited a rescue turkey to Christmas lunch - and invited the press along to take photographs.

"We did that for Peta (the campaign group, People for the Ethical Treatment of Animals]. It was my idea but he approved of it 100 per cent. During the dangerous dogs outcry he did break into kennels to rescue dogs - but he would always leave 1 or two behind.

"He could never have been a politician or a diplomat because if he believed something was right he would do it."

The Duke himself was the first to realise his fading memory was a sign of something serious.

"We went out for dinner - I was going to broach the subject of memory - but he turned to me and said, 'It is not going to get any better is it?'"

At first the couple kept their fears to themselves but the rest of the family found out when Kay went into hospital in 2005.

"I had an operation on my back in England.He was in a bed and breakfast over the road - you could see the hospital from the window - and he phoned up his daughter and said, 'Where's Kay?'"

There were persistent rumours that her husband's illness was connected the years when he was a heavy drinker. He became teetotal in 1992.

"It was very hurtful when I heard people saying it had something to do with his drinking. We had all the tests carried out, but there was no sign of alcohol-related illness."

As the Duke's health and memory declined, his wife worked hard to maintain his quality of life.

"Instead of saying, 'Do you want coffee or tea?' I would say, 'I am having a cup of tea - do you want one?'

"He was such an active and intelligent man, which such a wonderful sense of humour. But gradually, bit by bit he forgot how to do things.

"Alzheimer's is no respecter of rank. It can hit the highest and the lowest in the land."

In August 2009 the Duke fell at home and fractured his hip and was taken to the Edinburgh Royal Infirmary for treatment. By now his dementia was in an advanced stage - he had limited speech and was prone to wandering out of bed during the night.

"The night of the operation I was told I had to leave at 8:30, when visiting hours finished.

"I asked the nurses not to put a catheter in as he had already passed urine but after I left they did it anyway.

"When I came back in the morning he was bleeding. He had pulled the catheter out during the night. I was also told there had been 'an incident', by which I believe they meant he had fallen."

The Duchess was so upset she delivered an uncharacteristic show of rank: "I said, 'If you want to go down in history as the ward that killed the Duke of Hamilton you are going the right way about it'.

"That night we were allowed a nurse, who sat beside his bed."

She believes health authorities need to rethink the way they treat patients with dementia as a matter of urgency.

"The most important thing is that we get dementia-trained nurses into every health board in Scotland."

Fortunately, the Duke made a good recovery from his hip operation but his mind and memory continued to fail. "At the end he was still mobile, but had very little speech, then he started finding it hard to swallow.

"He became very thin. Three days before he died he said to me, 'I think I will be dead.'

"I said, 'Don't think you will get away from me that easily Angus Hamilton.'

"After that he never got dressed again.

"During those last days a visitor came. She was sitting on the couch and Angus held out his hands to her. We tried to work out what he wanted. Then we realised. He was trying to help her up. He was a gentleman until the end."

The end, when it came, was peaceful: "We were in bed together. I didn't think he was going to die that night.

"I said, 'You know darling, there is nothing to be afraid of. We can never be separated. There is no chance of that.We'll always be together.

"Then during the night there was a change in his breathing. I looked at him, held him and at 3:15am he took his last breath.

"I stayed beside him until the doctor arrived and that was the most peaceful three hours I have ever had in my life - listening to the birds singing outside the window."

It is to honour the man she loved and their extraordinary relationship that Kay Hamilton is now determined to improve the care of others with dementia.

"Angus was always a practical man, he always wanted to make a difference to others. That is why I am so determined to help others in his name."

Many people suffering from dementia will be admitted to hospital at some point, but as the Duchess of Hamilton discovered it can be a distressing experience for the patient and the family.

She has pledged to help Alzheimer Scotland raise 1.5 million to fund skilled hospital-level dementia nurses for every health authority in Scotland. She said: "I have memories etched, of Angus, sitting in the hospital bed, looking distraught at what had happened to him.

"If a nurse experienced in care of dementia could have talked with us, understood his needs, then his stay and our experience would have been so very much easier. That is why this appeal is so important."

There are only 14 trained dementia nurses working in Scottish health authorities - of which three are funded by Alzheimer Scotland. Raising 1.5m will fund an extra ten nurses for three years, after which the posts will be funded by the health authorities.

There are about 71,000 people in Scotland with dementia. Henry Simmons, chief executive of Alzheimer Scotland, says: "In an average 900-bed hospital, approximately 150 patients will have some form of dementia.

"This appeal will help us to fund more specialist dementia nurses, who will work to promote best practice and influence the way that people with dementia experience the NHS for the better."