In the Midst of Life

The patient was old, undernourished, and in deep shock. Her blood pressure was very low, hardly sufficient to maintain circulation, so cardiac stimulants and oxygen were given. The patient did not have adequate respiratory drive to breathe, so a tracheotomy was performed. The anaesthetist made an artificial opening through the windpipe, and passed an endotracheal tube directly down the trachea for oxygen and gases to be delivered under positive pressure. The gas used was ether, and Mrs Ratski went into an ether convulsion, which is a serious complication. Antidote drugs had to be given intravenously, the gas was stopped, and a mixture of oxygen and carbon dioxide administered instead. The patient was in theatre for three hours,and for most of that time the anaesthetist was battling for her life. Several times the theatre staff thought she had died, but each time the anaesthetist resuscitated her successfully.
    Mrs Ratski returned from theatre to the ward. Post-operative intensive care units did not exist in the 1950s, so the ward sister and her nurses took that responsibility. We had been alerted that the patient’s condition was grave, and a small side ward had been prepared. The ward sister received the patient and checked her condition, and a nurse was told to stay with her. There were no monitoring machines in those days. A patient’s post-operative condition was maintained entirely by nursing observation and assessment.
    Slavek had been obliged to go to work. He had been told to ring the hospital at midday, and that he could visit in the evening. When he telephoned, he was told that the operation had been successful, but that his mother was still under the anaesthetic. He came to the hospital directly from work, but she still had not regained consciousness. The breathing tube in her throat frightened him, so he asked the sister about it, and she told him that it was only temporary and would be removed when his mother had enough strength to breathe normally. He asked about the blood transfusion entering her arm. What was wrong with her blood? The sister quietly explained that it was normal procedure after major surgery to give blood. An oxygen cylinder hissing away beside her bed alarmed him, but at the same time it reassured him – everything possible was being done for her. Everything would be all right. She was sleeping and looked comfortable, so he slipped away.
    On the second evening, he was alarmed to find his mother’s hands tied to the side of the bed. The sister explained that it was necessary, because his mother had tried to pull the tube out of her throat. His mother turned her head and looked at Slavek, her eyes full of anguish, but she could not speak because of the tube in her windpipe. He stroked her hand and kissed her forehead, whispering, ‘You’ll be all right, mother. They know what they’redoing.’
    On the third evening the oxygen cylinders had been removed, but the tube was still in her throat, and her hands were still tied. Slavek asked about the tube, and the sister said that there would be a ward round tomorrow, so a decision would be made then. He felt reassured, and told his mother that the surgeon would see her the next day, and that everything would be all right.
    But everything was not all right, and we, the nursing staff, knew it.
    In the first instance, our patient’s recovery from anaesthetic had been abnormally prolonged. She had not shown any signs of consciousness for more than twenty-four hours, and when she did recover, she seemed excessively agitated. She had attempted to throw herself out of bed, and had to be restrained by two nurses. She tried to shout, but could not make a sound, because of the tube in her trachea, so she tried to pull it out. We nurses had to prevent her from doing this, and we explained that it must stay in place for a few days. Only then did we realise that she neither spoke nor understood English, and it took us some days before we appreciated how difficult this was going to be. She watched us carefully, and when a nurse’s back was turned she tried to pull the tube out again, and had to be restrained. The naso-gastric tube, which was attached to a machine for continuous suction, was another focus of worry. Then Mrs Ratski discovered the blood drip entering her arm, and had a go at that, too. The night sister had ordered her hands to be tied to the sides of the bed, because during the night when fewer nurses were on duty she would have