I turned to the second page of his notes, and read, ‘Next of kin – none.’ That was all. Dr Hyem, a Viennese Jew, living in the wrong place at the wrong time, had lost his entire family – murdered. At the end of life, all that could be recorded of these atrocities was ‘Next of kin – none.’
Within a few days Dr Hyem improved. His heart rhythm had stabilised and his breathing became easier. The oedema lessened somewhat, and the cyanosis all but disappeared. He was able to get up and sit in a chair. He could walk to the lavatory. He could take a bath, with a nurse’s help. He could talk without exhaustion, and even read a little. His diabetes had been thrown out of control by the attack, and the amount of insulin he had been taking for many years was no longer applicable. His urine had to be tested, and an insulin injection adjusted twice daily, otherwise he would have developed hyperglycaemia and acidosis. But, all things considered, there was a big improvement.
I was so happy to meet him again and to be able to give him my friendship and professional care. Each evening we talked, and this was when he told me a little of his personal wartime experiences. But I am sure he left much untold, things that were too painful to put into words. I expressed my surprise, once, that he was not bitter. He said: ‘We have to forgive the unforgivable. But that does not mean forget. These things should be remembered. But if we do not forgive, we will poison our lives, and the lives of others, and evil will win.’
I thought of my poor Uncle Maurice, who had spent four years in the trenches in France and Flanders in the First World War, and whose whole life had been eaten away by savage hatred and resentment. He spent forty years hating mankind. Dr Hyem’s philosophy of forgiveness was not only wiser, but kinder to himself.
We could talk only for short periods because, firstly, it tired him, and secondly, I was night sister, with a whole hospital in my charge and many duties to attend to. Nonetheless, I was grateful for the opportunity to get to know him better.
Sometimes he spoke of death, as my grandfather had. ‘My time has come and I am content. “Everything in its season”, as the prophet teaches us; “there is a time to live and a time to die”.’
On another occasion he said, ‘I have seen so much horrific death in the camps and I think about the spirits of the departed more and more as I draw closer to them.’
Little sentences or half sentences, here and there, built up a picture of his philosophy.
‘Why did I survive? I often wonder. Why did I have to bear the perpetual pain? To die would have been easier. I’m glad my time has come at last.’
On another evening, he was reading his Hebrew prayer book when I approached his bed. He looked up, with a wry smile.
‘From ancient times Jews have described death as “God’s kiss”. Wishful thinking on the part of a people who have suffered for two thousand years at the hands of cruel men, I think. Death is only a “kiss” if it comes naturally. What do you think, eh, Jenny Lee?’ (He always called me by that name.)
One evening, he said to me, ‘I know enough about the human body to know that one day, perhaps quite soon, I will have another heart attack and that will be the end of my life. I want it to be the end. I don’t want anyone messing about with me, trying to pull me back from the brink.’
‘It’s unlikely,’ I said. ‘This is a small hospital. We only have a resuscitation room with two beds, and I don’t think it is very well equipped. Anyway, you are seventy-eight and no one with any sense is going to try resuscitating a man of your age.’
‘That’s a comfort. Nonetheless, promise you won’t let them do it.’
I promised, but said he should speak to the consultant and to the ward sister about his wishes. He told me that he had already done so.
These were the last words that Dr Hyem spoke to me. I went off duty at 8 a.m. During the day he suffered a massive heart attack and was not expected to live. The onset had been sudden. He was reading the morning paper and gave a cry, clutching his chest, and collapsed unconscious. It was thought that a blood clot, which is always liable to develop if the circulation is sluggish, had probably lodged itself in one of the pulmonary arteries.
Dr Hyem was treated as an emergency, with all the drugs and equipment available at the time, and he rallied.
At 8 p.m., when I went on duty, Dr Hyem was semi-conscious, but stable. If it had not been for the drug treatment and oxygen he would have died, probably within an hour or two of the infarction. However, he was close to death. I looked at him with deepest sadness. To lose an old friend is not only sad, but always tinged with regret, regret for all the little things left unsaid or unfinished. I had planned, in my mind, that, as he seemed to be getting better, and as he lived quite close to us, he could become part of our family group. I knew that my husband, an intellectual if ever there was one, would like him and be endlessly fascinated by his conversation. Perhaps my little girls would like him, too, and see him as a grandfather; this would be a source of happiness to him in his old age. All these plans – and now it was not to be.
A nurse was taking his pulse and blood pressure when I went into the ward. I told her to stay with him, and that I would return when I had completed my first night round in order to sit with him.
I completed the night round and returned to Dr Hyem, taking with me all the hospital notes and records from my office, so that I could write them up while I was sitting there. I told each of the nurses and the night porter where I would be, if needed.
I sat behind the curtains in the dim, green-shaded light. I listened to the hushed sounds of the ward. Dr Hyem was no longer in pain. He was unconscious, or perhaps semi-conscious, and breathing slowly but deeply. His pulse was not perceptible at his wrist, but I could feel the carotid beat, very faint and irregular. His eyes were closed, and his expression peaceful.
At ten o’clock we turned him, a nurse and I, and he seemed to be faintly aware of the movement. I leaned over him and said slowly and clearly, ‘Hello, Dr Hyem. It’s Jenny Lee. I am here with you, and I won’t go away.’ He made the faintest sound to indicate that he had heard and understood. I took his hand, and his fingers moved in response. Then he sighed and drifted into sleep again, or was it unconsciousness? Where are the boundaries in these states? Later, he was beginning to feel hot, so I took a cold flannel and wiped his face, neck and chest. Again a faint sound, a sort of appreciative ‘Mmm …’ on the outward breath told me that he knew I was there, and that he wanted me there.
I have always been convinced that unconsciousness, in a dying patient, is not wholly without perception or feeling, or even thought. The dying, even to the last breath, know who is with them. Perhaps they drift in and out of awareness of this world and indifference to it. Perhaps they are entering, or perceiving, another world that we cannot see. Where does life begin, and life end? Where do two worlds meet, or is it an illusion? We will never know. Birth, life, and death are mysteries and it is fitting that we should never know.
I sat with Dr Hyem for an hour or more. A telephone call came through, and briefly I went to another ward to answer a nurse’s request to check a drug, but returned to my friend’s bedside. He looked very peaceful, and I felt sure he would slip away before morning. The darkest hour before dawn is the time when the forces of life leave the body most frequently. After the tragedies and traumas of his life, I was glad that Dr Hyem was dying peacefully and painlessly.
At about midnight, an urgent call came from the children’s ward. A baby who had been operated on for repair of a cleft palate was having breathing difficulties. I said I would come and asked a nurse to stay with Dr Hyem.
The baby was choking and turning slightly blue. The night nurse had been feeding him water, but a little must have been regurgitated into the nasal cavities, making him choke. It was alarming, but not terribly serious. Holding him head down, patting his back to encourage coughing, and sucking out the fluid, restored normal breathing fairly quickly. The baby took no harm. However, one look at the nurse told me that she was in a far worse state th
an the baby. She was deadly white, shaking and sobbing uncontrollably. Not long before that incident a baby had died in a nurse’s arms, and the whole ward had been sad and subdued. No doubt the girl was thinking of that. She kept saying, ‘I don’t know what happened, Sister. I don’t think I did anything wrong. Was it my fault?’ I had to reassure her and told her it could have happened to anyone. I suggested she should sit quietly, cuddling the baby, for a while, and asked another nurse to bring her a cup of cocoa.
With one thing and another, I was away from the medical ward for longer than was originally expected.
OPEN HEART RESUSCITATION
(also known as Direct Manual Compression)
I returned to the male medical ward to resume my vigil with Dr Conrad Hyem.
Tread softly as you draw near to the bedside of a dying man, for the space around him is holy ground. Speak in hushed tones, with awe and reverence, as you would in a cathedral. Let not the mind engage in trivial thoughts. The awesome majesty of Death can only be met in silence.
As I approached the ward, I was aware of light and commotion coming from within, and when I entered, I saw that it was coming from Dr Hyem’s bed. The curtains were drawn, but brilliant light was shining and half the men in the ward seemed to be awake.
I pulled aside the curtains and found a full-scale open-heart resuscitation being carried out by three doctors, one of whom, the registrar, had a scalpel in his hand.
Dr Hyem was lying flat on his back. His chest had been cut open on the left side, from the sternum to the lower back ribs. Blood was oozing out, and the smooth chest muscle was glistening in the bright light. Rooted to the spot, unable to breathe or make a sound of protest, I watched the registrar with a swift, easy movement slice through the pleural muscle, revealing the ribs.
‘Retractor,’ he demanded.
I found my voice. ‘No! No! What are you doing? Stop! Stop it, I say!’
He ignored me. He inserted the retractor between two of the ribs, and turned the ratchet to open the double arms of the instrument to their full potential. I heard a rib crack.
‘Stop it!’ I shouted.
Perhaps he had not heard, as he continued with the ratchet, and I heard a second rib crack.
‘Scissors,’ he demanded.
By then I was getting close to hysteria. I took a couple of steps forward.
‘What are you doing? Stop it. He’s dying – can’t you see that? Leave him alone.’
The doctor was cutting through the pericardium with surgical scissors. He muttered, ‘Who the devil are you? Get to hell out of here.’
He inserted his hand through the open chest wound and grasped Dr Hyem’s heart; then he began a series of steady, firm compressions.
There was blood all over the place, dark venous blood, black and sticky, covering the doctor’s white coat, and the sheets and pillows scattered across the floor.
‘It’s fibrillating badly, but at least there’s some movement,’ he said as he continued his compressions. ‘How long have we been at it?’
‘Two minutes twenty,’ replied one of the housemen.
‘Not bad. If we keep it up, we should win. Here. You take my place. Then you will know what to do next time.’
He withdrew his hand and stepped backwards. One of the others took his place and inserted his hand through the hole in the chest wall.
‘Can you feel the heart?’
The young man nodded.
‘The ventricles fibrillating, like a jellyfish wriggling?’
Again the houseman nodded.
‘You can? Good. Now just squeeze the lower myocardium – regular – firm – steady; one squeeze about every second. That will force the blood upwards, out of the ventricle into the upper chamber and into the circulation.’
This was obviously a teaching exercise.
The older man stood up and stretched his back. He wiped his bloody hand down his coat.
‘That was good,’ he said with satisfaction. ‘We are winning. I can feel a pulse in the jugular.’
Then something spine-chilling occurred. Dr Hyem, lying flat on his back, opened his eyes and stared into the brilliant light shining directly on him. His mouth hung open, and a rasping roar was emitted from the depths of his throat. It was a ghastly noise, like the whoop or howl of an animal in agony. The sound rose to a crescendo and then stopped abruptly, and the silence that followed was almost more dreadful than the roar.
I ran around to the other side of the bed and took Dr Hyem’s head and shoulders in my arms in a futile attempt to protect him. He looked at me, I swear he looked at me, and in his eyes was reproach. He had said, ‘When my time comes I want it to be the end. I don’t want anyone messing about with me.’ I had promised that he would die peacefully, and I had let him down.
I have lived with that look of reproach all my life.
‘I told you to get out of here, woman. Now clear off and don’t interfere,’ barked the registrar.
‘I am the night sister,’ I exclaimed, ‘and Dr Hyem is in my care!’
‘Bloody fine care you give, trying to be obstructive.’
Then to the team, ‘He’s coming round. Excellent. Ah! There’s the porter with the machine. Splendid. Bring it over here.’
He spoke to the two younger doctors. ‘Fix it up, and it can take over the massage. Now, we will want a central line through the iliac vein, and another in the subclavian, but try the iliac first, and a shot of adrenaline direct into the myocardium. Get a tracheal tube down him, and fix up the oxygen supply.’
Then again, to me: ‘Look, I told you to clear off.’
‘I am the night sister.’
‘I don’t care if you’re the Queen of bloody Sheba! Get out of the way. I want to get a tracheal tube down him.’
I was pushed aside, and one of the young doctors tried to insert the catheter into the lungs. It is not an easy thing to do, and he had to make several attempts.
‘Arch the neck. It will go down easier. More than that, pull the head backwards; you’ve got to locate the trachea. It’s no good if the thing goes into his oesophagus. We don’t want to oxygenate his guts.’ He laughed at his own joke, and the others laughed in unison.
‘Have you no respect for the dead?’ I bleated, despairingly.
‘He’s not dead, you stupid cow. He’s coming round. This has been highly successful.’
There was nothing I could do. I covered my face with my hands to hide my tears and fled to the office. The nurse whom I had left sitting with Dr Hyem only half an hour earlier came in.
‘Are you all right, Sister? You look dreadful. Can I get you a cup of tea?’
I couldn’t look up. ‘What happened?’ I moaned. ‘How did this happen?’
‘I was sitting with him, like you said, Sister, and he stopped breathing, and I couldn’t feel a pulse, and I didn’t know what to do, so I rang the emergency button.’
That was all that was needed. A young, inexperienced nurse, seeing death, possibly for the first time, and quite possibly frightened at being alone, and me, her senior, unavailable. So she had pressed the emergency button, and a resuscitation team arrived. Once started, the process could not be reversed. And, as the registrar had proudly stated, it had been highly successful.
LAZARUS
The wound in Dr Hyem’s chest was sutured under local anaesthetic, the broken ribs realigned, and the chest bound, to keep them in place. We then raised him to a semi-recumbent position and changed the bed linen. Oxygen was directly entering his lungs, so his colour was good, and the cardiac machine maintained his heartbeat. Fluid was dripping into his circulation, and drugs were introduced to raise the blood pressure, to stimulate the heart muscles, and to thin the blood; antibiotics, a clot-buster and diuretics completed the cocktail.
The registrar and his team were exhilarated by their success. They had saved a life, and that’s what medicine is all about. Lazarus had been raised from the dead. It was a miracle of modern medicine.
The team prepared t
o leave, all of them exhausted. By then it was 3 a.m., but adrenalin had been pumping through their bodies and now they were worn out. The registrar apologised for his rudeness. ‘It’s the tension that gets me,’ he said. ‘I’m not aware of it. I snap at everyone, they tell me.’ He left with instructions about monitoring the cardiac, pulmonary and blood pressure responses to the machines, and the adjustments that should be made in the event of physical changes.
Dr Hyem breathed quietly all night. His pulse and blood pressure were steady. The drip dripped, the oxygen hissed, the cardiac machine hummed quietly, and the twenty or more men who had been awake during the commotion of the night fell asleep as dawn was breaking.
I had many other duties to attend to in the hospital, but stayed with Dr Hyem as much as possible, and, as I looked at him breathing quietly, I began to feel ashamed of myself. He was alive. Why should I have wished the old man dead? It was unworthy of me; wicked even. He was alive due to the miracles of modern medicine. Nearly twenty years had passed since I had started nursing and everything had changed, scientific advances in drugs, surgery, in technology. I was old-fashioned, I told myself, and must embrace these changes.
At 6 a.m. I started my morning round of the hospital. It was still dark, but the return of day could be felt in the air – sleepy sparrows began to chirp, an early morning milk delivery could be heard in the streets, the first kitchen workers were arriving. As I finished my round, light was returning, and the fears of the night, enshrined in all our fairy tales, were receding. Had the darkness played its part in exaggerating the terror I had felt for Dr Hyem, I wondered?
By about 7 o’clock I had finished the morning round and was able to return to Dr Hyem. The registrar was there before me, checking the dials and drips, listening carefully to his patient’s heartbeat and lungs, taking a sample of blood for path lab investigations.
‘I owe you an apology.’ I said, ‘I doubted you.’
‘No, no, not at all. It can be pretty scary, but as you can see, it can be successful.’ He held out his hand towards Dr Hyem, who looked peaceful. ‘Not every attempt turns out as good as this one. In fact, if I’m honest, most fail. But it’s worth having a go, just to get a result like this.’
In the Midst of Life Page 23
