The Patient (9 page)

Jonathan was sleeping. His father reached out with his hand but stopped short of stroking his head. Instead, he lifted his eyes to heaven in a silent prayer for his son. Thoughts flew through his mind of the first day this boy had come into his life, a gift from God. He and his poor departed wife, Jonathan's mother, had raised him, and it was heartbreaking to see him going through this now.

Jonathan stirred. ‘Hi, Dad,' he said. He could see the fear and concern in his father's face – the same expression he had seen when they had visited his mother in hospital together when she first got sick. ‘I'm sure it will all be fine, Dad.'

‘Sh, shh …' he hushed Jonathan. ‘I know you hate it when I go on, but can you find a bit of comfort in Psalms, just this once? “But thou, O Lord, art a God full of compassion, and gracious, long suffering, and plenteous in mercy and truth.”'

What Jonathan really wanted was for his father to hug him, to hold him, to tell him it was all going to be OK, but
his father was not capable of such a show of emotion, even though none could fathom the depths of his love for his only son.

Jonathan replied, ‘“And all his sons and all his daughters rose up to comfort him; but he refused to be comforted; and he said, For I will go down into the grave unto my son mourning. Thus his father wept for him.”' He uttered the verse perhaps in a vain attempt to impress his father, or perhaps because it captured so well the pain and anguish of the man who now stood before him.

Mr Brewster smiled a broad grin, proud – and slightly amazed – that his son could remember the lessons he had for so long fought to teach him. ‘Genesis, chapter 37, verse 35,' he whispered, and Jonathan noticed that his eyes had become teary. Mr Brewster reached out and held Jonathan's hand. They stayed together in silence for some time, and then he left to let Jonathan rest.

Tracy had paid for the television above Jonathan's bed to be connected, and when she came to visit they turned it on to the mid-morning news.

‘The interim report of the review of the Victoria Hospital instigated by the health minister today announced that the hospital was adequately resourced for the level of patients it received.

‘The minister did admit that the winter had seen a greater than average pressure on beds, because of the increase in admissions from pneumonia and flu-related illnesses. Welcoming the review, the minister went on to say that his department looked forward to receiving the final report of
the task force and would take their recommendations on board as the department moved forward with the process of reform in the public-hospital system.'

The patient across the room put his speaking device onto his throat and said as loudly as he could, ‘Bullshit! Fucking liars, the lot of them!' He then said to Jonathan, having managed to catch his eye, ‘Look around you, mate. This place is a disaster. Have you used the toilet yet? It stinks. It's dirty. The food they give you tastes like shit. The nurses are nowhere to be found. Maybe there isn't enough of them, maybe they're just lazy. How many times did you have to press that buzzer of yours to get someone to fix that saline? Look at it, it's run out again. You'll get clots, and nobody gives a fuck!'

A nurse came in carrying a two-litre bag of saline to replace the empty one. ‘Shut up, Bill!' she called over to him. ‘God, he raves,' she said to Jonathan. ‘He used to be a surgeon in this hospital. He smoked a lot. Then he had to have his larynx taken out because he got cancer, and now he can't practice. Every time he comes in, he raves about how things
used
to be – before the nurses “took over”.' She shook her head. ‘We just run around every shift trying to do the best we can.'

‘The nurses always pull that overworked stunt on us to shut us up!' Bill retorted. ‘Doctors can't say anything. We're just picked on. Silenced. Nurses turn into bureaucrats, and then they control the health system. Look around, Miss Nurse. Are you proud of what you've created?' Bill paused for breath, as he had plenty more where that came from. When he was the surgeon at the Victoria, he was known as a zealot for quality and safety. He turned back to Jonathan: ‘Ask Miss Nurse over there how many patients here have a complica
tion
caused
by a nurse or a doctor? One in five! One in five patients suffer an adverse outcome as a result of incompetence by someone here. Then some committee changed the definition of adverse outcome so that the rate came out at one in ten. Tell me we don't live in a totalitarian state.

‘Instead of reform, they announce new reviews. They send nurses off to do projects: improve the patient's MRI experience! Improve the patient's Obstetrics experience! For God's sake, the whole house is falling down and they are deciding on light fittings.'

‘Shut up, Bill! You're disturbing everyone.' The nurse's tone was irritated but amused.

‘I cannot be shut up! They can take out my larynx, but I'll still shout! People deserve a better health system.' But Bill had to stop because of a coughing paroxysm brought on by his attempts at vehement shouting.

‘Breathe slowly, Bill,' said the nurse, walking across to his bed. ‘Just breathe it through.' She rubbed his back, calming him.

Perhaps it was Bill's rant that brought it on, but Jonathan suddenly realised it was time to test the former doctor's assessment of the state of the toilet. He told Tracy that he needed to go. He swung his feet out of bed and onto the floor and stood up.

‘Stay there, Mr Brewster. I'll come help you,' called the nurse.

‘No, no, you've got your hands full. My wife'll help me,' he said. His head was light, and he wobbled at first, but he regained stability quickly. Tracy organised the various tubes around him and placed the bags of fluids on a mobile drip stand for Jonathan to take with him.

He slowly edged towards the bathroom in the corner, which was shared by the four of them, and pried the door open. Tracy offered to come in with him, but he said he couldn't go if she was there. As she waited on the other side, he closed the door and surveyed his surroundings. His immediate response was to gag. There was a rank odour, the shower stall was stained and mouldy looking and the toilet seat had urine all over it. That was enough to give Jonathan constipation. He turned around and came straight out. ‘I've lost the urge,' he said to Tracy, who helped him back to bed.

Minutes later, Derek appeared for a morning ward round. ‘How are you today? The return looks good,' he said, investigating the bag that was collecting Jonathan's urine. ‘No temperature? Pain seems well controlled. I think we might take the catheter out and see if you can pass water and send you home. OK? I'll leave instructions with the nurses. You have done very well. Normally, I would keep you an extra day. OK? See you in my rooms when the pathology results are in. Well done.' And with that he was gone.

It was six hours before the catheter was removed. By then, it was too late to send Jonathan home, due to the time it would take to complete all of the paperwork necessary to discharge him.

When I did my evening ward round, Jonathan was looking well and was sitting alone, tapping on a laptop. I was always surprised that no matter how sick male patients were, they always hung on to work, often bringing it with them to the hospital. I have never seen a female patient do that. Men are compelled to proclaim their profession, carrying on with the telephones and laptops; they continually desire to grasp at the world.

‘How are you feeling, Mr Brewster?' I asked.

‘Well, fine, I suppose. I wish I knew more about what's going to happen to me.'

‘We'll know soon enough. Most cases of bladder cancer are superficial and do not progress, so it is possible that the operation you've had will have knocked it on the head. Now, we just need to make sure that it never recurs, and your doctor will probably talk with you about the need to have regular check-ups.' I was trying to reassure him.

‘My wife and I have won a trip to Africa in a charity auction, all expenses paid. It's only a few months away. Do you think we'll be able to go?' he asked.

‘Look, I really don't see why not. However, we do have to wait for the results and work out what else needs to be done. Where in Africa are you going?' I asked.

‘We're going to South Africa, Johannesburg, and then to Zambia to see the Victoria Falls.'

‘Do you have any kids?' I asked.

‘Yeah, two girls. Not that I ever see them. I seem to be always at work or travelling. Maybe it's time to change all that.'

He wasn't going to change. I had seen so many patients express the desire to change their lives after illness. They never did. Sometimes, they changed superficial aspects. Several I knew had divorced after a major illness – but they soon married someone who was almost an identical twin of their first spouse. Sometimes, patients claim they're going to work less or travel more or spend more time with their kids. Once the illness is cured, they forget their promises.

‘I hope you do. Life is very short,' I said.

‘I hope you don't mind me asking, doctor, are you a Muslim?' He had obviously guessed by my name.

‘Yes, I'm Lebanese in heritage. I was brought up here but born in Ghana, in West Africa.'

‘Really? I visited Accra once. We had a contract there. It's a fascinating place.'

‘
Nurse!
Someone! Help!' It was the lady whose husband was in the next bed. He had stopped breathing.

I rushed over to start resuscitation and simultaneously felt his chest and his carotid-artery pulse, on the side of his neck. There was no pulse. I thumped his chest.

‘Doctor, can I see you for a moment?' It was Virginia, the charge nurse. She had her arm on my shoulder and was pulling me back, away from the patient. I ignored her for a few seconds.

‘He is NFR,' she whispered.

‘Are you sure? Is it documented?' I asked. The initials stood for ‘Not for resuscitation'. There came a time in the care of a patient when it was regarded as being unethical, even cruel, to resuscitate him when his breathing or heartbeat stopped. Continuing to be alive was no longer feasible. It was illegal to end life but not illegal to refrain from administering life-saving care. Some called this euthanasia, passive euthanasia. However, the decision was always a difficult one and needed to be made in consultation with the family. His wife would have been called upon to agree to this decision prior to the notes being marked with ‘not for resuscitation'.

I always felt a great sense of frustration when it was apparent that the community seemed to expect doctors to make decisions about life and death. I had often heard criticisms of the torture that was inflicted on patients by doctors applying the full force of medical care to an elderly patient whose life had become unbearable. Yet, doctors were also part of the community. There were those who supported euthanasia and others whose religious
beliefs would never allow them to make decisions of this nature. There were those for whom even the NFR sticker was an abomination. Instead of expecting doctors to make these decisions, society needed to have a dialogue that included euthanasia as a discussion topic. The politicians would not legalise it until they had a clear message that the majority of voters accepted euthanasia as a viable and moral end-of-life alternative.

‘Yes, I have the notes here,' she said, showing them to me.

I stopped and looked up at the elegant woman standing by his bed. I took his pulse again. Nothing.

‘I'm sorry, there is nothing we can do. He has passed away,' I said and gently came round the bed to console her. She had signed the NFR form herself, but when he had stopped breathing she'd panicked.

‘May he rest in peace,' I uttered. She placed her head on my shoulder and cried. Virginia took over and whispered to her about arrangements and the mundane issues that follow death.

I left the woman in her care and left the ward. As I was walking down the corridor, I ran into Jacob, the slow meticulous surgeon. He was about to start his ward rounds, so I began walking back with him.