In the Midst of Life (5 page)

Matron looked at me and sighed.

‘I can see you are upset, Nurse, and you raise questions I cannot answer. Nobody can. When I was your age, I was a young nurse in the war working in France. Death was all around us. Millions of young men died in that war. Millions. Yet I remember one who came to us with his face blown apart by an explosion. Where his nose, mouth and chin should have been there was just a great, bloody hole. Still, he was alive, and his eyes moved, and his mind obviously worked, though he could not speak because he had no mouth or tongue. The surgeons patched him up; they grafted skin over the shrapnel wound, and he recovered. But he had been a handsome young man, and was now left with two eyes and a ghastly-looking hollow with a hole in it, and a tube in the hole, so that liquid foods could be passed into his stomach.’

It was now my turn to gaze at
her
without speaking.

‘I was about eighteen, and like you I thought: “Why have they done this? Surely life with such a face, if you could call it a face, is worse than death.”’

I did not know what to say. There was a knock at the door and the maid entered with a tray.

‘Thank you, Bertha. Put it here,
please.’

Matron poured tea.

‘These are deep and terrible subjects, Nurse, to which there can be no answers. I know you are upset, and I understand.’

‘That is a terrible story, Matron. I would not want to live with a face like that. What happened to him?’

‘He lives in an ex-servicemen’s home. He cannot live in the community, because everyone stares and points at him.’

‘So he is still alive! Is he happy?’

‘I do not know. He seems content – he is a gardener, and gardeners are always happy people. And he has a dog. When I was your age I thought as you do. You have just said: “I would not want to live with a face like that.” But I very much doubt if that man would say that he would rather be dead.’

‘But he was
young,
and he had a whole future in front of him, even with such an affliction. Mrs Ratski is old, she has come to the end of her life. She said she was going to die; she achieved what she wanted to do, and then said she was content to die. The obstruction in her intestines would have meant her suffering would have lasted only a few hours, and she would very likely have died in her son’s arms, like my granny died in my grandad’s arms.’

‘But the medical and nursing professions cannot allow anyone to die, if it can be prevented.’

‘But who are we doing it for? For the benefit of the patient, or the benefit of the medical profession? We say that the welfare of the patient comes first, but I am not so sure. The practice of medical skills and techniques seems to come first.’

‘I am certain that Mrs Ratski has been treated for the best of motives – to preserve life.’

‘But for the rest of her days she will be a decrepit old invalid who will be a burden to everyone!’

‘Human life is precious.’

‘And human death is sacred. Or at least it should be – and would be, if we allowed it to be. In the short experience I have had, sitting with the dying, I can say that the last few hours are always peaceful, almost spiritual. Wouldn’t you call that a sacred time?’

‘Yes, I agree, Nurse, and I have had thirty-five years of nursing
experience. I don’t really know what is meant by the term “death agony” because I have never seen it.’ She paused and thought, then added, ‘Perhaps, in a few people, I have seen what can be described as a struggle with death, and it can be distressing to behold. But for the vast majority of people death is gentle, tender.’

‘Well, it’s not like that for Mrs Ratski. The agony has been going on for five or six weeks, and it will continue. She has been deprived of a gentle death.’

Matron said nothing, but I blundered on.

‘She thinks she is in a concentration camp, you know, and that we are using her as a guinea pig. She can’t understand what we are doing, or why. She is terrified all the time, terrified of
us.’

‘Yes, I know. That is something no one could have anticipated.’

‘But she has lived in fear, Matron, for weeks. It is tragic, terrible. I can’t bear to see it.’

I was getting tearful, and had to stand up and walk about again. ‘And there’s another thing. All these injections she’s having. Dozens of them, daily. And now we’ve started paraldehyde. It’s mind-bending, Matron. It replaces one madness with another, different sort of madness.’

I walked the length of the room and back, then sat down.

And there is another thing that worries me, Matron. All this business about “she must have”. It is written in her notes. “If drugs are refused, to be injected.” And we, the nurses, have to inject them. It seems wrong.’

A nurse must obey medical orders.’

‘She does refuse drugs, all the time, so we hold her down and inject them. Isn’t that assault? And who commits the assault? The doctor who orders it, or the nurse who does it?’

‘I cannot answer these questions. Perhaps a lawyer could, but I doubt it. If life-saving drugs are to be given, they
must
be given, and any court of law would uphold the medical necessity to save life.’

‘Well, I don’t agree with the law!’

‘Nurse, you are young and passionate. You are trying to understand a subject too deep for understanding. Death used to be as
you have described it – your grandmother had a heart attack and just died in her husband’s arms. That is how it used to be for the vast majority, but not any more. Medical science has found hundreds of death-defying tactics, and, as this century unfolds, thousands more will be available to us. We do not know where it will end. Perhaps we will come to a point when human beings are unable to die.’

‘That is a frightening thought, Matron.’

‘Yes, it is.’ Matron stood up, all four feet eleven inches of her, indicating that the interview was over.

‘I advise you, Nurse, not to talk too freely with other people on this subject. You will not be understood. In fact you may be positively
mis
understood. All sorts of sinister interpretations could be drawn from your remarks. It is a dangerous
subject.’

Hospitals in the early in 1950s were small, enclosed worlds, especially for nurses. We lived communally in the nurses’ home, and all our meals were taken together. Consequently, we exchanged news of hospital life all the time, so whilst I did not directly look after Mrs Ratski after the first five or six weeks, I was able to keep up with her progress, and made a point of doing so.

Mrs Ratski recovered sufficiently to go to the convalescent home attached to the hospital. It was a lovely house, with gardens sloping down to the Thames, which she seemed to enjoy.

The nursing staff tried to teach her how to manage her colostomy, but she did not understand, and seemed incapable of learning. She just muttered to herself, and poked it (the gut has no nerve endings, so can be touched without causing pain). She seemed intrigued, but quite incapable of understanding how to cope with it. After three weeks in the convalescent home, it was decided that she could return home under the care of a district nurse.

A hospital car brought Mrs Ratski home. Her daughter-in-law, Karen, watched with dismay as the driver helped the old lady out of the car, up the garden path and into the sitting room. She went straight to the sofa, muttering to herself, and pulling her shawls round her shoulders.

The district nurse arrived, kindly and helpful.

‘Where is she going to sleep?’ she enquired.

‘I don’t know. She slept on the sofa before.’

‘She can’t do that now – this sofa is not suitable. I can arrange to have a bed sent from the social services. It’s wonderful what this new National Health Service can provide, isn’t it? I’ll go now, and come back this afternoon.’

A hospital-style bed arrived and the men put it up; the sofa was
put in the garden shed. Karen watched the whole proceedings, and bit her lip. Her nice sitting room was ruined.

The district nurse returned in the afternoon.

‘I’ve got sheets and pillowcases, and cotton blankets that can easily be washed, and all free from the NHS. Isn’t it wonderful?’

Karen was not so enthusiastic. Washing blankets was not something she had anticipated.

Mrs Ratski sat on the edge of the bed looking uneasy, and still muttering.

‘I don’t know what you are saying, dearie, but let’s get these clothes off you, and into bed, shall we?’ The nurse turned to Karen. ‘I’ve got to show you how to clean a colostomy.’

‘What’s a colostomy?’

‘Oh, dear. Didn’t anyone tell you she’s got a colostomy? Well, briefly, the rectum has had to be sealed, and the colon is opened on to the skin surface and the body’s waste product goes into a bag. I’ve brought a supply of colostomy bags with me to leave with you.’

Karen didn’t fully understand until she saw her mother-in-law’s abdomen. Two huge and angry-looking scars ran the length of the wrinkly old skin, and on the left hand side a pink, protruding thing burst on to the surface. It was covered with a plastic bag containing brown liquid and had sticky stuff around the edges. Mrs Ratski looked at her abdomen, and poked the bag, and tried to pull it off.

‘No dear, don’t touch.’ The nurse pulled her hand away. ‘She’s been doing this all the time in the hospital, they tell me. They can’t get her to understand that the bag has to be left in place. Have you seen one of these before?’

No, and I can’t bear it! I just can’t bear it. I think I am going to be sick.’

‘You’ll get used to it, dear. The first sight is always the worst. The bag has to be changed when it gets full. It’s not so difficult when you get used to it. And anyway, I’ll be coming in morning and evening to help you.’

The nurse pulled the bag off and wrapped it and its contents
in gamgee paper tissue. The huge pink thing, raised from the surrounding skin, looked like a sea anemone attached to a rock, thought Karen, as she watched rigid with horror and disgust.

‘It is important to clean the area carefully, otherwise the skin can get very sore,’ said the nurse helpfully. ‘Watch me.’

Deftly she cleaned around the colostomy with sterile water and applied zinc cream. ‘I’ll leave this with you,’ she said.

‘I can’t do that!’ said Karen in horror.

‘I think you will have to, dear. Usually a patient learns to do it herself. But from what I have read in the patient’s notes, I doubt if your mother-in-law will ever be able to.’

‘I can’t, I know I can’t,’ said Karen plaintively.

‘Well, perhaps I can come in at lunchtime to help you out for the first few weeks.’

‘Few weeks!’ Karen was alarmed. ‘How long will this go on for?’

‘I can’t say, dear. No one can. But she will have the colostomy for the rest of her life. Now, we must talk about other things. What is she going to do when she needs a wee? She can’t get upstairs. What did she do before?’

‘She went in the garden.’

‘Oh, so you’ve got an outside lavatory. That’s useful.’

‘No, we haven’t. She went behind the blackcurrant bushes.’

The nurse was shocked. Karen explained how she’d wondered where the old lady did her business and had been totally horrified when she first spotted her crouching outside. She’d tried talking to Slavek about it, but he’d been unwilling to broach the subject with his mother.

‘Well, she can’t do that sort of thing now. She will have to have a chamber pot. Have you got one?’ Karen shook her head. ‘Then I will get one from NHS Supplies.’

The nurse packed up her bag. She was kindly, and saw Karen’s agonised expression.

‘Don’t worry, my dear. The first few days are always the worst, and I’ll be popping in every day. You’ll soon get used to it
.’

Karen went upstairs to her bedroom, and threw herself on the bed, and cried as she had never cried before.

The days stretched into weeks, and Karen never did get used to it. She could not bring herself to touch the colostomy, so Slavek did. He did not find the task difficult or nauseating. He had cared for farm animals in his youth, had attended birthings, squeezed teats, cut abscesses, applied poultices, and a colostomy was much the same. Added to which, he wanted to spare Karen the burden. The district nurse was true to her word, and came in twice a day, often three times.

Karen kept the children away from their grandmother as much as possible. After school they went up to their bedroom to play, and she joined them. To reach the garden they had to pass through the living room and kitchen, so she discouraged this, taking them to the park instead. Slavek did not like it, and thought her determination to keep the children away from his mother was wrong, so he asked her why she did it.

‘I don’t want my girls to see that sort of thing. They are too young.’

‘They’re not. Children need to see everything in life. Old age, sickness, birth, death, everything.’

‘It upsets them.’

‘That’s only because you tell them not to be upset.
You
put the idea into their minds first. If you said nothing, they would take it in their stride. Children always do.’

Karen changed tactics.