In the Midst of Life

by Jennifer Worth

That was the end of the conversation.

  We still called the glamorous woman who brought in illicit bottles of whisky Mrs Winterton, but I looked on her with very different eyes. A saint or a fool, which was she? And is there much difference? The Orthodox Church has a concept of the Holy Fool – one who is a fool in the ways of the world, but wise to the ways of God. Are we all ‘fools to love’? Not so; I think the opposite – that the lover is all-wise and sees in the beloved the goodness that no one else can see.

  We could not halt the metastases in Mr Roberts’ emaciated body. The treatment was proving to be worse than the disease, so after three doses of radium the Chief proposed a halt. He spoke to Mrs Roberts, who said: ‘I know. God’s will be done. The Lord God say, “Can you command the sun to rise, or the sun to set? Can you move the moon from her course? Did you set the stars in motion? Can you number the days of a man?” I know what you saying, and I see it clear. He is my husband and the father of my children, and I will speak with him. He is ready to die, and will be grateful.’

  We stopped all active treatment and increased his sedation and she asked us: ‘Is it always right to reduce pain? I am not sure. We are born in pain and some of us will die in pain – is this wrong? If there is pain and suffering in this world, there must be a meaning to it. Some of us have to learn this meaning.’

  I said, ‘We always try to relieve suffering.’

  ‘Yes, I know, and because I am not sure about the right or the wrong, I must leave it to you to decide.’

  Then she laughed, a big chuckle that surprised me.

  ‘There is one thing, Sister, that I am quite, quite sure about. Quite sure. He does not need food. Your nurses bring him food, they try to feed him, and he push it away, he turn his head. They try again. It is a nonsense, a child’s game. He cannot eat, and does not want to eat.’

  She chuckled again, and her face creased with merriment.

  ‘Does a man need porridge or scrambled eggs when he come to the Pearly Gates? No way. He need a clean mind and a pure heart.’

  I laughed with her, and said that it was hospital practice to feed patients, even to the point of force-feeding.

  Her merriment vanished. ‘You not goin’ to force-feed my husband,’ she said emphatically.

  ‘We will not try to feed your husband any more, I assure you. But what about drinking?’ I asked.

  ‘I give him water, it trickle out his mouth. A nurse give him water, he try to swallow, but the water, it choke him. Does he need water, Sister?’

  I said we all need water to live.

  ‘But he is dying, not living. It is different.’

  I said that if he had no water his death would come more quickly.

  ‘But does that matter?’ she asked innocently.

  I had to pause. What a question! Does it matter? I had asked myself that question many times but never dared to voice it. Hearing the words spoken aloud by this woman was a shock. Do we try too hard to keep people alive? And what are we doing it for?

  I said, ‘I cannot allow a patient on my ward to die of thirst. It is against all my teaching, principles and practice.’

  Yes, Sister, I understand you,’ she said quietly.

  ‘If he has no water his kidneys will make less urine, and there will be more blood and infection in what little urine is in his bladder. It will be very bad for him.’

  ‘I understand,’ she said.

  ‘We planned to put up a drip today.’

  She jerked up and looked me straight in the eye. ‘No. No drip.’

  ‘Why? Does your religion forbid it?’

  No. We are Methodists, not Fundamentalists. I don’t think it is forbidden. It just seems wrong, unnatural.’ Her face dissolved in tenderness. ‘He is at the point of death, Sister. He is a good man, and has led a good life. Let him rest in peace.’

  I said I would discuss the matter again with the doctor. But I also said that, as he could take very little fluid by mouth, it was important to keep his mouth and throat clean and moist, and that one of the nurses would show her how to do this with swab sticks and moistening solution.

  After that conversation, his wife never left him. The family, varying at different times between eight and twenty people, more or less camped downstairs, but Mrs Roberts strictly controlled the number of people who saw him. We put him into a single room, and no drip was installed. The family was assiduous in keeping his mouth and throat moistened, and he took a few ounces of water now and then. Some of the younger members of the family helped the nurses to clean and change his bed, and to attend to pressure points. They liked doing so, and almost fought for the privilege.

  The family brought food for Mrs Roberts, and we provided cups of tea and coffee from the ward kitchen, for which she always thanked us most graciously.

  It was a busy morning, and she carried her empty cup into the kitchen, saying, ‘I see you are busy, I do not need to trouble you to collect my empty cup,’ and she put it on the draining board.

  When she got back her husband was dead.

  It happens this way, time and again. So many people will say something like, ‘I only went to answer a knock at the door, and when I came back she was gone,’ or, ‘I just went to the window to draw back the curtains and look down at the garden, and when I turned round, he was dead.’

  Why does the person so often die during the minute or two when the watcher is absent? There must be a reason. It happens this way far too frequently to be a coincidence. Dying is not passive. Dying is not something that happens to you without your knowledge or control. Dying is an active process, in which the soul is the leading actor.

  There is more, much more, to human life than mere flesh and blood, bones and brains. There is a living spirit that is the spark of life, and when it knows that the flesh, which it has animated for a while, is decaying, the soul wants to slip away quietly, when no one is looking.

  FORGET-ME-NOTS

  ‘Show us your wedding ring, Sister.’

  I held out my hand for the ladies in the day room to admire.

  ‘It’s lovely, dear. You look after it, and your man. Keep them special.’

  ‘What’s he like, Sister? Tell us about him.’

  They crowded round, the female interest in love and marriage alive in the face of death. I had brought the photo album of our wedding for the ladies to see.

  ‘He looks nice,’ said one.

  ‘You can’t trust men,’ said another.

  ‘Oh, don’t be a sourpuss. There’s good and bad everywhere, and I’m sure Sister’s chosen a good one.’

  ‘Mine broke my arm for me.’

  ‘Mine could never stop. Fifteen pregnancies I had. Even on his deathbed he was after it. He’s gone now, good riddance. I’ll bet he’ll ask the angels for it.’

  A burst of laughter among the women. I loved them all, and was glad to see they still retained their sense of humour. We nurses were always told that we should keep alive an interest in life, tell the patients about our days off, our interests, families, boyfriends and the dances we went to. I even encouraged nurses to flirt with the men – anything to divert their minds. Cancer patients often feel surprisingly well, in spite of the malignancy, and keeping up hope was an important part of our work.

  I tried to tell them about my young husband.

  ‘He’s very clever. He’s a schoolmaster.’

  ‘Oh, fancy that. A schoolteacher, eh? That’s nice. Did you hear that, dear? Sister’s new hubby’s a school teacher.’

  ‘Uh?’

  ‘A schoolteacher, dear, Sister’s new hubby. Oh, she’s not with us, poor soul. It’s a shame.’

  ‘What’s he look like? Tell us.’

  ‘He’s tall and good looking, very distinguished,’ I said.

  ‘Ooh, that’s nice,’ from the cheerful one.

  ‘Handsome is as handsome does,’ from the sourpuss.

  ‘Blue eyes or dark?’

  ‘Blue.’

  Little Mrs Merton looked up wistfully. She had not
spoken, but had been twisting her wedding ring round and round her finger. She was very small, and had a childlike quality that you sometimes meet in the very old. Her eyes were particularly appealing. They revealed patience, kindness and sadness, but also humour. We knew she had a sarcoma that was consuming her bones, but she thought the pain was due to rheumatism, and we let her think this.

  ‘My Bert’s eyes were blue,’ she said, ‘forget-me-not blue. He was a lovely lad, my Bert, no one like him. Before he went, I gave him a little picture. It was a woodland scene of forget-me-nots growing under chestnut trees. He always said my hair was chestnut brown, so it was like a little picture of us both, you see.’

  ‘That’s nice.’

  ‘That’s pretty.’

  ‘What a nice idea,’ the ladies chorused.

  Mrs Merton looked pleased and flattered.

  ‘I thought so, and so did he. He took it with him when he went off to the Great War. I’ve got his likeness here. You can look at it. I’m that proud of it.’

  She took a locket from around her neck, and opened a small silver clasp.

  ‘That’s my Bert.’

  She handed it around lovingly. Boyish features with smiling eyes looked out at us.

  ‘He was such a lovely lad, always laughing, always happy, proud of his uniform – oh, I can mind him now, marching off.’

  She smiled as she took the locket back and hung it around her neck. ‘I’m never parted from these – my wedding ring, and the likeness of my lovely lad. He was nineteen when we were married in 1915, and two months later he marched off to the war. Oh, I can mind him still, waving and smiling, and marching off.’

  ‘Did he come back?’

  ‘No, he never came back. Smiling and waving, he was. But my lovely lad, he never came back.’

  The clock ticked on the wall, and the evening sun cast long shadows through the window. Traffic could be heard in the street, but in the day room no one spoke. Fifty years of love, still burning after only two months of marriage, could be felt by all the women.

  Then Mrs Merton spoke again.

  ‘When I got a telegram saying “missing presumed dead” I knew he was gone for ever. I cried for two years, and for ten years I ached all the time. All the time –just here.’ She put her hands up to her chest. ‘Here it was, the ache. It was terrible. Terrible it was, far worse than the rheumatics.’ She chuckled and looked around her. ‘Rheumatics is nothing compared to the pain of losing your only love. A great wound, it was, open and bleeding just here.’ She pressed her hands on her chest again. ‘I can’t explain the ache, the feeling, but it was there all the time, never went away, ten years, the ache, ten years…’ Her voice trailed away.

  There were sighs of compassion among the ladies.

  ‘Wicked it was – half our lads gone.’

  ‘War’s a crime, I say.’

  ‘My aunt lost four sons.’

  Mrs Merton spoke again, her bird-like features eager. ‘And then, after about ten years, something happened. I can’t explain it, but it did. One morning I woke up and – d’you know what?’

  She looked around brightly. We shook our heads.

  ‘No. What?’

  ‘The pain was gone. Quite gone. The wound had healed over, and my Bert was there inside me.’

  She hugged her chest protectively.

  ‘Here, inside me, my Bert with his forget-me-not eyes.’ She chuckled. And I’ve never been alone since. He’s always inside me, laughing and waving, and marching off.’

  *

  Two weeks later a tragedy occurred that nursing staff always dread, and which usually happens so quickly that nothing can be done to prevent it.

  Mrs Merton never wanted to be a trouble to anyone. She was not consumed by fierce independence as some people are, but with self-effacing humility. ‘You girls have got people more sick than me with my rheumatics to look after. I can manage fine. I’ll not be bothering you,’ she would say.

  I knew that it was not really safe for Mrs Merton to walk alone, but the alternative would have been to confine her to bed with cot sides around her. This was bad for a patient, both mentally and physically. It deprived them of self-respect and dignity, and was often the start of an almost infantile dependence on the nurses, which frequently hastened the end, quite apart from the fact that it usually caused acute unhappiness. I have seen patients rattling their cot sides in impotent rage and frustration, shouting or weeping, which can have a terrible effect on the morale of other patients in the ward. If the disturbance got too much, I have seen narcotics being given to quieten the patient. This is bad medicine, and bad nursing.

  I decided that Mrs Merton should be at liberty to wander around as much as she wanted. In retrospect, this was the wrong clinical decision, but so often in medicine decisions have to be taken, and it is not until later that one can say if they were right or wrong.

  One afternoon, Mrs Merton was going into the day room for tea when the diseased bone of her femur snapped. She fell and shattered her pelvis and was taken to the orthopaedics department at the Royal Free for surgery. The femur was pinned and plastered without too much trouble, even though the bone was riddled with cancer, but the fractured pelvis was another matter. It was diseased and shattered in several places, and bits of jagged bone threatened to penetrate her internal organs. The surgeons did what they could, but the result was that the pelvic bone did not mend, and the external wound never healed, as the stitches could not hold the muscle together. Suppuration started around the surface, but it must have been spreading beneath the muscle, because suddenly the whole wound opened up, exposing bone, tendons, ligaments, and muscle, all sticky with pus. The wound was so deep and so extensive that you could get your hand into it.

  We did our best. We gave antibiotics to try to reduce the infection and the fever. We packed the wound with flavine gauze and antibiotic powders. We were able to supply one of the new electronic air beds which kept the left side of her body free from bedsores - she had to be nursed on her side all the time because the hip was shattered from the iliac crest in front to the coccyx at the base of the spine. Fortunately, the surgeons had inserted an indwelling catheter into her bladder whilst she was in theatre, so we did not have the nightmare of dealing with the normal urination of a patient in her condition.

  The one thing we were able to do which really did help Mrs Merton was give her the Brompton Cocktail regularly. In spite of the seriousness of the wound, Mrs Merton was surprisingly unaware of its extent, because she could not see it. She knew that something was wrong with her hip, because nurses came at frequent intervals to change the dressings, but she could not turn her frail old body to look at it. She knew that her right leg was in plaster, and we supposed that she thought this was the full extent of her injuries. Incidentally, the plastered leg had to be adjusted, and it was one of the most unnerving things I have ever seen because the exposed bone and ligaments of the pelvis moved as we repositioned the leg. It was a job I always did myself, with the help of a nurse, and I insisted that when I was not on duty, an experienced staff nurse should do it. This was a task that could not be left to a couple of inexperienced student nurses.

  What is it that we need at the end of life? Peace and love are the words that spring to mind. Weeks, or months, of gradual decline usually precede death, but then, very often, something intangible happens. It is as though body, mind and soul have been tuned differently, like tuning down a string of a violin or cello, so that the vibrations that create the inner resonances of the instrument are altered, and the quality of sound is different. I can find no other way of describing these subtle changes that occur before death takes over. A skin change, something different in the eyes, a weariness of movements, a quieting of the mind – there are many subtle alterations that can be seen, and they are very real. And then the end is usually fairly swift. ‘Let me bide, dears,’ my grandfather had said to his daughters a few days before his death. ‘I want for nothing.’ And they allowed him to die quietly. Most dyin
g people seem to feel the same – the Angel of Death brings peace. Harassing a dying person to return to the life they have already left is a pointless exercise, and in many instances, cruel.

  Love is not something that we receive in proportion to our merits; love is a gift of God. And I like to think that ensuring peace at the end of the day is an act of love on the part of the nursing staff. St Paul, in his Letter to the Corinthians, said that Faith, Hope and Love are the greatest of God’s gifts. I suspect that most doctors and nurses will say that faith does not play a great part in tranquillity at the hour of death, because few people mention religion or ask to see a priest. But who are we to judge? None of us knows what is going on in the mind of a dying man or woman, especially if that person is beyond articulate speech. Faith is a private matter, usually held deep within a person, quite impossible to recognise or understand if you have no faith yourself.

  There are many reports from people who have returned from a near-death experience, and they are all remarkably similar. Testimonies come from every part of the world, and in all periods of history. Without exception they speak of a profound sense of well-being, and overwhelming feelings of peace and calm. Some people have said they felt safety and comfort, and loving arms enfolding them. A woman has said she felt as though she was drowning in a deep green sea, and the depths contained an inexpressible joy and fullness of life that pulsed more strongly than it had ever done in ordinary life. Many have likened the sensation to lying on the surface of dark, smooth waters, and of being gently supported. Some people have spoken of having no will of their own, but a feeling of weakness and trust and languorous ease. There are also many reports of an enveloping darkness in which a light is shining. Some speak of a longing to reach that light, others of being led gently towards it. One man spoke of a feeling that he was floating between a black sky and a black sea, between which a phosphorescent light shone. A long tunnel of velvety darkness, with a light shining at the end of it, seems to be the common link. There are also reports of beautiful music, often choirs or strings – but no tune that can be named.