In the Midst of Life

time of dying, especially at the actual moment ofdeath. It was regarded as a disgrace to the ward sister, or staff nurse in charge, if a patient died alone.
    We prepared Mrs Cox for her third treatment with radium. Two porters came and lifted her on to the trolley and I went with her to the radiotherapy unit, holding the sheet above her breast so that the men would not have to look at it.
    Half an hour later I accompanied her back to the ward. The radiographer told me that her blood pressure had dropped during treatment. Her skin was even more sallow than it had been before and her pulse was very weak, her blood pressure barely perceptible. Although her eyes flickered when I spoke to her, and she gave a little moan, she did not appear to be conscious. The porters wheeled her back to the ward and lifted her on to the bed.
    We never knew whether the radium treatment had made her more comfortable, because that afternoon, peacefully, quietly, Mrs Cox accepted death with the same uncomplaining resignation that she had accepted life.
    ‘Dinners is hup, Sister.’
    Gladys, the indispensable ward maid, stood in the doorway, arms folded, legs apart, her face expressionless. She knew more about the hospital and how it functioned than anyone, but she never intruded, never grumbled, and above all, never gossiped. One could rely on her discretion, something that, in a cancer hospital, where most of our patients would die, was essential. Thoughtless remarks, a hint or a nudge here or there, could spark off an atmosphere of uncertainty that could escalate, causing patients and their families distress.
    The morning had been hectic with, as usual, a shortage of staff, too many duties, and too little time in which to get them done: dressings to change; a drip to install; blood to take; patients to prepare, take to, and return from therapy; the drugs to take round and DDAs to check; a couple of admissions; a patient discharged, with her drugs and treatments to organise and explain to the daughter who was collecting her; the linen arriving from the laundry; someone needing catheterisation; another a bath whichhe could not manage himself. Morning coffee had been disrupted by three or four radium patients vomiting; the telephone ringing, with a message from dispensary – a drug was available, could a nurse come and collect it? But why could the dispenser not send it up to the ward? They were too busy, the woman said. Does no one ever imagine that the ward is too busy? As we had needed the drug badly for two days, I sent a nurse to get it. And in the rush of work the oncologist – the Chief, we called him – arrived to see a new patient.
    He found me in a side ward, washing the mattress of a patient who had died during the night.
    ‘This is a surprise, Sister. Haven’t you got a nurse or an orderly to do that sort of thing?’
    All the nurses are busy, and one orderly is off sick. Anyway, a sister should never be too grand to do the menial tasks. I want this room for Mr Waters because I don’t want him to die in the main ward if it can possibly be avoided – it’s unsettling for the other patients. None of them see themselves getting to that state.’ I cleaned the sides of the mattress. ‘There, it’s done now, and I’m with you.’
    Together we went to the bedside of the new patient. Hospital protocol required that I should stay with the consultant whilst he remained in the ward, but Hannah appeared in the doorway with her ‘dinners is hup, Sister’, and a look of command on her heavy features.
    ‘Then I had better not delay you, Sister,’ the Chief said. ‘We will be doing the full ward round tomorrow morning.’
    I walked swiftly to the kitchen, to the ward orderly in pink, the half circle of nurses in blue, each holding a tray, the electric food trolley plugged into the wall, waiting my attention. It had always seemed extraordinary to me that the serving of patients’ dinners occupied such a large part of a sister’s duties (the whole process took the best part of an hour), and that all nursing staff looked to her for the lead. It was a relic of the old days, when drugs and surgery were in their infancy, and when so many people who came into hospital were chronically malnourished, so that the dietary needs of each patient wereimportant.
    I tucked the tea towel into my belt to protect my uniform from gravy splashes, and removed the aluminium lids from each container. I served a full dinner for several patients, which