In the Midst of Life

by Jennifer Worth

  ‘I’m sorry about this beastly sucker, but it will make you feel better,’ I said, trying to avoid his panic-stricken eyes. His lungs were struggling under some terrible oppression and breathing was an intolerable strain. Any respiratory death is distressing to watch, but a natural anodyne – a sudden dimming of consciousness due to oxygen starvation of the higher centres of the brain – comes at the peak of suffering, and mental and physical deterioration descends as swiftly as a hawk dropping on its prey.

  ‘Mr Waters, we think you would be better off in the small room. It has two windows, and they can both be open all the time. It will make your breathing easier,’ I said softly. He nodded, and picked at the sheet. I was alone with him, but I could sense a figure hovering beside me. Could he see or feel this ghostly presence? None of us will know until we get there.

  I had called the porters, and they arrived with a trolley.

  ‘I think it will be better if we move the whole bed, rather than lifting him on to a trolley, and then on to another bed,’ I said. It would be more difficult for them, because the corners were awkward, but they did not question my instructions.

  Not an hour too soon, we moved him. Two days earlier he had been sitting upright in bed, leaning forward a little, his cheeks flushed, his lips tinged blue as his chest heaved tumultuously at four times the normal respiration rate. His eyes had been clear and his mind alert, as he noted people and things going on in the ward. Now the struggle to live had departed, and weariness had overtaken him.

  I called a junior student nurse, and showed her how to fix up the oxygen and the sucker, and how to use them, and explained the details, which were so much better than ten years previously when I had been a student nurse. I told the girl (she was barely more than a child, with fresh features and the downy skin of youth) to stay with the dying man whilst I went to fetch the injections. What huge responsibility we place upon a nurse’s shoulders, I reflected, as I went to the dangerous drugs cupboard. So often they come straight from school, the classroom, the hockey field or the gym, and we expect them to remain with the dying, a task that the majority of mature people would run away from in fear and revulsion. Does this give nurses a heightened sensibility of living, to be so closely acquainted with death? Certainly, nurses always seem to be full of life and vitality, with an inexhaustible capacity for laughter. I had found in nurses none of the lethargy and self-absorption that one often noticed in young girls, contrary to what one might expect, given the nature of our work.

  Radiotherapy could not help the malign growth in Mr Waters’ lungs. It may have halted the progress of the cancer by a hair’s breadth, but it made no real impression on the inexorable course of the disease. Mr Waters had smoked himself to death, and there was nothing that medicine could do to reverse the destruction. For two days he flickered in and out of consciousness, his lungs bubbling and gurgling as he slowly drowned. But his suffering was not as great as appearances suggested, because he received devoted nursing care – and the Brompton Cocktail every four hours. His mind was not conscious of his condition, or of his surroundings, and he showed no signs of pain. We did not try to bring him back from wherever he was, by forcing him to drink this or to take that, nor any of the multifarious futilities of energetic medicine. His perceptions were so dimmed by weakness and weariness that his life was ending slowly, in a dream state, rather than in true awareness.

  Each morning when I came on duty I expected to find the side ward empty, but for two mornings he was still there. How extraordinary is life, that one can hang on in that condition, neither alive nor dead? But on the third morning the room was empty, and the night nurse reported that the flickerings of life had given way to the smothering curtain of death.

  FAMILY INVOLVEMENT

  Mr Elias Roberts had an enormous family, which seemed to expand with each passing day. They were Jamaican and had immigrated to England in the early 1950s, seeking a better life, better education, and better prospects for their children. They had stepped off the boats in their Sunday best, raw and hopeful, into an exhausted and war-torn England. A better time was a long way off. Jobs were plentiful because rebuilding Britain was a priority, but finding somewhere to live was near impossible. Mr Roberts had eventually found a single room at the top of a derelict house for himself, his wife and their two youngest daughters, but the older boys and girls had had to make their own way.

  Mr Roberts was admitted to the Marie Curie Hospital suffering from prostate cancer, which had been treated by prostatectomy in the Royal Free Hospital. He had come to us for radium treatment but the widespread metastasis in the bones was clear evidence that the treatment had come too late.

  When I was a young girl, I was told that men who had difficulty urinating carried a catheter coiled in their hatbands. When they needed to pass water, they catheterised themselves. At first, they would inevitably develop an infection, but the body’s immune system is built to fight that, and once these men had got over the initial bouts of infection, the body became immune to the germs lurking in the hatband.

  Testing for cancer was not routine. Some men went to a doctor, but the treatment was fairly rudimentary – diuretics, potassium citrate, no alcohol, barley water – none of which was effective. Later, in the 1940s, the female hormones oestrogen and progesterone were prescribed in the hope of reducing the enlargement, but it is doubtful if these treatments did much good. Consequently, a great many men developed such massively distended bladders, filled with retained urine, impossible to pass normally or by catheter, that abdominal entry was necessary and a supra-pubic catheter had to be inserted to drain the fluid. I was in theatre once as the ‘runner’ - the lowliest member of the team - when a man was wheeled in with a massive lump in his lower abdomen; it was his bladder. He had not been able to pass urine for weeks. It was impossible, even under anaesthetic, to get a catheter past the enlarged prostate, so a supra-pubic insertion was made and more than a gallon of urine was drained off. The man died from surgical shock.

  That was an extreme case, and the worst I have seen, but a great many men had to endure weeks in bed with indwelling catheters, twenty-four-hour drainage, daily bladder irrigation, uraemia, antiseptics and antibiotics before a prostatectomy could be attempted. Sometimes I felt that the catheter in the hatband would have been the better option.

  This was all embarrassing and unpleasant for a sensitive man because there were very few male nurses in the profession; so young girls almost always performed such tasks. Incidentally, nursing procedures were comparatively basic. The following is taken from Wilson Harlow’s Modern Surgery for Nurses (1956):

  There are various means of retaining an indwelling catheter in the male urethra. A common method is to attach four pipe cleaners, or two pieces of tape, to the catheter. The ends, which should be 4—6 inches long, are then brought up and fixed to the penis by a piece of Elastoplast or bandage. A similar retainer can be constructed out of a piece of sheet rubber fitted with holes and collar studs to fasten it to the penis and catheter.

  I do not know what humiliations Mr Roberts had been subjected to before or after the prostatectomy, but when he came into the Marie Curie, the cancer was widespread, and there was no hope of cure. Nonetheless, the Chief decided on six doses of radiotherapy to try to control the spread, and eight if the results were favourable.

  Mr Roberts’ wife and two of their eldest sons came with him. She was an unexceptional woman, apart from two trusting brown eyes that forced the word ‘integrity’ into your heart. She said that they would prefer to look after her husband at home, but they had only one room and had to climb sixty-four stairs to reach it. The Chief said that we would look after him well, and that they could visit any time, day or night. Doctors, I have found, make these rash comments without the slightest thought to the practicalities involved!

  Mr Roberts said, ‘My days are numbered, so I thank you, kind doctor. My family will continue my life that is running away from me.’ He squeezed his wife’s hand and said ‘The Lord
giveth and the Lord taketh away. Blessed be the name of the Lord.’ His wife whispered, ‘Blessed be God in his wisdom.’ The two boys said ‘Hallelujah’ and then one of them let out a howl. His mother said: ‘Abraham, you stop your noise right now. The good sister no want your noise in her nice quiet ward, you hear me?’ From such a small woman the effect was surprising and instantaneous.

  The Chief smiled and left, saying, ‘I leave it in your capable hands, Sister.’ The wife left also, as the two youngest girls were due home from school, but the two young men said they were doing the night shift at a nearby warehouse, and could stay. As it was close to visiting hour, I agreed.

  In those days, visiting hours were very strict. Too strict, I felt, but hospital discipline had to be maintained. I was glad to relax the rules when I could, but the Chief’s comment about unlimited visiting day or night was going a bit too far. Three o’clock came, and the visitors who had gathered outside were admitted. One or two wanted to see me, but mostly I was left in peace to check the drugs and equipment and to complete what little paper work there was to be done. At four o’clock I asked a nurse to ring the bell to inform people that visiting hour was over; almost simultaneously the clip, clip of high-heeled shoes was heard in the corridor, and three women walked straight into the ward. The eldest one was smartly dressed in a suit, and the two younger women wore pretty dresses. They all had hats and white lace gloves. I called to them, and they turned.

  ‘We come to see our daddy,’ one of the girls said.

  ‘But visiting time is over,’ I replied, ineffectually.

  ‘We come any time, day or night. The doctor, he say.’

  ‘Yes, but—’

  The older woman stepped forward and folded her arms.

  ‘No but! Who are you, anyway?’

  ‘I am the ward sister,’ I said, hoping I sounded confident.

  ‘You!’ she said scornfully. ‘You too young to be ward sister. In Kingston, ward sister is a big, strong mamma, fifty years of age, a woman who know how to handle men. Not skinny girl like you, no way.’

  I was completely squashed.

  Visitors were beginning to leave and we were blocking the doorway. I stepped aside and the three women took it as a sign that they should proceed to Mr Roberts’ bed. The two men stood up. One of them kissed the two younger girls, calling them sister Faith and sister Mercy, and the other said to the older woman, ‘Well, well, Aunt Adoration, what you doin’ here? Long time no see,’ and he shifted on his feet with a smooth, boneless motion.

  ‘You no smirk at me, nephew Zachariah. I come to see my brother Elias, is sick man. You no smirk, or I wipe that smirk right off your silly face.’ The boy sat down and shrugged effortlessly, his shoulders moving like running water.

  They brought a chair for the woman, who sat very close to Mr Roberts.

  ‘Brother Elias, the Lord, He send a visitation—’

  ‘Is you the visitation, Aunt Adoration?’ said the boy.

  You be quiet, saucy puppy. Brother Elias, the Angel of Death come visit you, but you be strong in the Lord and be not cast down, hallelujah.’

  ‘Hallelujah,’ chorused the girls.

  Several visitors, still lingering, looked at them. It was time to intervene.

  ‘It is ten past four, and visiting hour is over. We have work to do, so I must ask you to leave.’

  The older woman settled comfortably in her chair, and took off her gloves, before replying.

  ‘The doctor, he say we can visit any time, day or night, his wife tell me. I come all the way from Notting Hill to sit with my brother Elias.’

  She removed the pins from her hat and stuck them into the felt, and removed her hat, a gesture loaded with meaning. ‘No way.’ she muttered. ‘Skinny girls, huh. Mercy, pass me my bag.’

  From the bag she removed two small cushions, one of which she sat on. The other she placed comfortably at her back before glaring at me.

  ‘No skinny girl tell Adoration Consolation da Silva what to do,’ she announced, and waved her hand to shoo me away.

  The girls giggled behind their hands, exchanging glances. The boys looked up to the ceiling and whistled silently. I was floored. It was time to see Matron.

  ‘What!’ she exploded, ‘the Chief said these people might visit any time, day or night?’

  ‘Yes. I was present when he said it.’

  ‘Doctors! We could run this place very much better without doctors,’ she muttered, as she accompanied me back to the ward.

  It was a fighting start, but unequal from the outset. Matron had the advantage of being the older woman, but she was also a softie, and no match for Mrs da Silva, who won on points. Eventually, it was agreed that when essential work had to be carried out, the ward would be closed and the family could wait in the visitors’ room, which was on the ground floor.

  The five people disappeared downstairs, and I went to Mr Roberts’ side. He was a very sick man, and looked exhausted and grey. He could hardly move, but he murmured, ‘Thank you, Sister.’ I checked his urine drainage bag, which was heavily bloodstained, and resolved he must have more potassium citrate and more fluids. I examined his supra-pubic wound, which looked clean and comfortable. I asked if he had any pain, and he breathed, ‘No more than usual.’ What did that mean? Pain is unquantifiable, and no one can assess the degree to which another feels it. He seemed to me to be a man of great courage, and as time went on we all began to recognise his outstanding qualities. Later, the Chief said to me, ‘I have seldom seen a man approach death with more nobility.’

  We had finished serving supper, the drug round and the essential bed changing and dressings, so I thought I would go to the visitors’ room to see if any of the relatives were still there.

  There were now not five people, but eight. I said that two could come upstairs to say goodnight to Mr Roberts, and Aunt Adoration stood up. But at that moment Mrs Roberts came in, accompanied by two younger girls aged about thirteen or fourteen, so I said that she should come up with her daughters. The aunt blustered about being first, but Mrs Roberts said quietly, ‘Hold your peace, sister Adoration. Do you not remember our dear Lord’s words “and the first shall be last, and the last shall be first”? Hold your peace. Come with me, Daffodil, and you also, Ruby, and we go softly, not to disturb the quiet of the evening.’

  Mrs Roberts was the only one who seemed to understand that a dying man needs rest and tranquillity, and, above all, peace in which to approach the ending of life.

  That was only the first day. During the next three weeks the stream of relatives was constant. One woman, a cousin I think, turned up with three small children, who were sweet and pretty, but a perfect nuisance. I couldn’t let them into the ward, so they raced around the ground floor. We let them out into the gardens, which were normally reserved for ambulant patients, and they shrieked and whooped as they chased each other around, to the anger of the gardener who regarded his garden as a sanctuary for the sick. We tried to limit visitors to two at the bedside, but frequently there were four or five. Brothers arrived from Birmingham, a sister from Bradford, and the sons and daughters who lived locally came every day.

  Poor Mr Roberts had no peace, but he never complained and, as far as we could see, never showed any irritation. He was always courteous, and even though he could barely move or speak, he would open his eyes and smile, and perhaps murmur, ‘It is kind of you to come. You are welcome,’ and then drift away again to where senses and perceptions are beyond our understanding.

  We all knew what would happen, and it did. Other patients, and particularly their relatives, started to complain. ‘Why is he allowed unlimited visiting time, when we are confined to the specified hours? It’s not fair.’ And it wasn’t, I had to agree.

  It was difficult for us, because at the same time we had a similar problem with Mr Winterton, who was an alcoholic. Alcohol is not allowed in hospitals, but you cannot withdraw all supplies from a true alcoholic and expect his body to adjust overnight. He will go berserk. So, a dai
ly dose of whisky was measured out for Mr Winterton at each drug round. This soon attracted the attention of the other men, some of whom called out good-naturedly, ‘Come on, Nurse – splash it around, be a sport.’

  Others complained, ‘If he can have whisky, why can’t we?’

  ‘Alcohol is not allowed in hospitals.’

  ‘Yes, but…’

  It was a circular argument. We even turned a blind eye to his wife bringing him extra supplies in a hip flask. She was a glamorous and interesting woman – an actress, who earned a lot of money on the stage – and she was devoted to him. Mr Winterton had real charisma, and all the nurses, myself included, felt it when he turned on the charm.

  One day I had a telephone call from a woman enquiring about Mr Winterton. You have to be guarded about supplying information to anyone who rings up, so I said that the patient was comfortable and that his wife had just visited.

  ‘I am his wife,’ replied the voice.

  Silence from me!

  Yes, I am Mrs Winterton. The woman who has just left is not his wife. Did she tell you that she was?’

  ‘Yes.’

  ‘Well, she isn’t. I am. What does she look like?’

  I described her.

  ‘I know her. She’s an actress, and a very good one at that. She is also either a saint or a fool, I don’t know which. She has kept that worthless man for years, moving him from one hotel to another along the coast. When the police pick him up drunk and disorderly, she sorts it out and pays the fine, then moves him on to another seaside resort. She has saved me a lot of trouble.’

  It’s hard to know what to say to a story like that. After deep thought I said, ‘Oh.’

  ‘Well, I had better give you my address and telephone number, so that you can inform me when he dies.’