In the Midst of Life

undoubtedly succeeded.
    Mrs Ratski lay immobile, hands restrained, in terrified silence. Soundless sobs racked her body, and tears streamed from her eyes. She could not swallow, because of the pain in her throat. Her mouth became completely dry and crusted, and had to be moistened and cleaned every hour, but even so her tongue was ulcerated and cracked. She did not pass any urine, so a nurse had to catheterise her, but she held her body completely rigid, to prevent anyone from parting her legs. Did she think she was being raped? I wondered. Maybe she had been, in a prison camp? A muscle relaxantwas injected, which she could not prevent, and the catheter inserted.
    The house surgeon, registrar and anaesthetist visited frequently to check her condition. On the fourth day Mr Carter did his ward round. These were always elaborate affairs – the consultant, accompanied by the ward sister, followed by his team of doctors, and another team of nurses who were there to do or get things. It was highly ritualistic, like a visit from royalty. The consultant would go round the beds of his patients, asking questions of the sister, checking notes, ordering another test or another path lab analysis, changing a drug, or the dosage of a drug.
    Mr Carter approached Mrs Ratski’s bed. She lay still, her lips compressed, only her eyes moving, as they flickered from one white coat to another. Mr Carter read through the notes. ‘I hear you have had trouble with her, Sister.’
    ‘Yes, sir. She keeps trying to interfere with the dressings.’
    ‘That is why you have tied her hands, I suppose?’
    ‘Yes, sir. It was the only way.’
    ‘Hmm. Well, we can discontinue gastric suction and start fluids by mouth. The blood drip can be removed after this bottle. That will help you, won’t it, Sister? I can’t give any instructions about the endotracheal tube. That’s a matter for the anaesthetist. Everything else satisfactory, Sister? Urine, faecal discharge?’
    Yes, sir. Do you want to see the wound, sir?’
    Yes. Get a nurse to remove the dressings.’
    I was at the back of the entourage, so I came forward and removed the dressing. Mr Carter looked at it.
    ‘Hmm. Satisfactory. You can remove one of the drainage tubes, Sister. We’ll take the other one out when we remove the sutures – we’ll have to take her back to theatre when we close the colostomy. You can do that, Ryder,’ he said to the registrar.
    Yes, sir.’
    ‘Well, everything satisfactory, wouldn’t you agree?’
    ‘Yes, sir, very satisfactory.’ said the registrar.
    And they moved on to the next bed. As they went, the tension in Mrs Ratski’s body visiblyrelaxed.
    After the round had finished, Staff nurse told me to assist her in the removal of the naso-gastric tube. The blood had very nearly run out from the bottle, so she removed that also. With the removal of the suction machine and the drip stand Mrs Ratski looked more like a human being.
    The anaesthetist came and said that he would remove the endotracheal tube under local anaesthetic. Staff nurse assisted him, and I was told to accompany her. The young house surgeon also came to watch, because he wanted to know how it was done. At the sight of another surgical trolley and several doctors and nurses, Mrs Ratski became visibly distressed. She could not make any sound, and her hands were still tied, but all her body language was that of panic. The anaesthetist took up a syringe of local anaesthetic, and, as she saw the needle approach her neck, Mrs Ratski’s skin lost all colour, and sweat poured from her brow. The anaesthetist retreated. He took her pulse rate.
    ‘It’s gone up to one hundred and twenty. I can’t proceed like this. She will have to have a general.’
    So, for a second time, Mrs Ratski was prepared for theatre and given a pre-med and muscle relaxant. Removal of the tube and suturing of the trachea and outer muscle and skin only took a few minutes, and then the patient was back in her bed.
    In the evening, when Slavek called, he was relieved to find his mother’s hands free, and all the machines gone. Her throat was bandaged, however, and she still could not speak; this was due to throat ulceration, which is very painful, but ultimately not damaging.
    After a few days she
could
speak, but we did not know what she was saying. We were able to sit her up in bed, and she could look around at the other patients. Fear and distrust were always in her eyes, and she reacted with dread whenever a