In the Midst of Life

be introduced into the stomach through the abdominal wall.
    Caroleasked, ‘Do you mean that for all patients, whatever their condition, three attempts must be made? Is the rule inflexible?’
    Apparently, it was.
    I was aghast when I heard this. Surely no doctor would be fool enough to issue a blanket rule covering all patients. No experienced nurse would attempt a distressing procedure
three times
on a dying patient without discussing with the doctor the course of action, or inaction, most appropriate. Where did the rule come from? Carole did not know. One can only assume that the rule came from the hospital authorities, or perhaps even some government guideline issued by bureaucrats who are not trained in medicine or nursing. Apparently, the nurse told Carole, the rule had been issued in order to offset any accusations about
not
feeding – in other words, starving patients who could not swallow. This is defensive medicine again – a curse destroying good medical practice.
    Carole took John home. It was a very difficult decision, because she knew that at home he would have no food or drink, and would die, whereas if he remained in hospital he could be fed artificially. But he was dying anyway, and had said that he did not want to die in hospital. They had discussed this over the two years they were given in which to contemplate his end. But still she hesitated. It was only with the help and support of John’s son and daughters that they jointly decided to take him home.
    The Integrated Care Pathway (ICP) for the care of the dying patient at home is based on studies showing that more than half of all terminally ill patients express the wish to die at home. It started as a pilot scheme, set up by the Liverpool Hospitals, to facilitate rapid discharge from hospital and to make available multi-professional care at home. Families looking after the dying need help, and the pilot scheme proved such a success that it is now provided by all NHS trusts.
    Carole signed all the necessary papers (of which there were many) and took John home. A team of medical, nursing and domiciliary help was provided by the hospital. Yet such is the lack of understanding in society that someone said to Carole:
    ‘Areyou bringing him home to starve him to death?’
    Carole was deeply shaken by this ignorant and cruel remark, but she collected herself sufficiently to reply: ‘No, I’m taking him home to allow him to go through the process of dying as comfortably and as gracefully as possible.’
    John was discharged from hospital on 5th October, 2006, in the care of his family, the Macmillan nurses and the local GP. When they had received him home, the doctor asked the nurses what they wanted to prescribe. Then he turned to Carole and said, ‘They know far more about this than I do.’John could not swallow, and so drugs were given to suppress secretions so that he did not choke. The nurses showed Carole how to keep his mouth and throat moist with glycerine swabs, and many other details of palliative nursing.
    Carole slept with him every night, which is the closest and sweetest communion two people can have. She said, ‘I lay beside him and held his hand. He was so relaxed, and I knew he was happy, and so I went to sleep.’
    On the night of 15th October, John Lewis died. Carole told me, ‘I woke up at one o’clock, and I knew at once that something had happened. The engine had stopped. He looked the same, but he was not there. He was quite warm and peaceful, and I think he had just slipped away quietly whilst I slept, as though he didn’t want to disturb me. It was a beautiful experience. It was a beautiful death.’
    She said nothing for quite a while, and then said ‘I had twelve perfect years with John, and in some ways the last two were the best of all. Now I can truly say “it is finished”.’

THE LIFE FORCE
     
    Leah had been my delightful neighbour for twenty-five years and I had always assumed that she was about ten years older than me. It was not until she broke her leg and went into hospital that I discovered she was thirty years older than me. Leah was a hundred and two.
    Leah was a widow and lived alone in her flat, and she fell at about eleven o’clock at night. Somehow, God knows how, she managed to haul herself to the telephone and ring for an ambulance. Steve and Sandy, neighbours who held a key, were awakened by the noise of an ambulance team trying to get in to the building. Steve went with them into her flat