In the Midst of Life

doctor came near. We nurses tried to feed her, but she refused; we could not persuade her even to drink.
    ‘If this goes on, she will have to have another saline drip. She cannot go without fluids,’ Sister said. In the evening when Slavekvisited she asked him to try to persuade his mother to drink. But even he could not. He told us that she thought we were trying to poison her, and he could not convince her otherwise. If he brought her drinks and food from outside, she would perhaps take it. So he did, and she drank and ate a little for a few days.
    On the seventh day her sutures and drainage tube were removed, and her condition appeared to be stable. On his ward round, Mr Carter said that if all went well the colostomy could be closed on the tenth post-operative day. He was confident of a complete recovery.
    In the early hours of the ninth day, the night nurse reported extreme restlessness, and signs of pain and distress. The night sister went to the ward and found Mrs Ratski doubled up in pain and moaning piteously. Her pulse was rapid and her temperature high. The abdomen was examined; it had become rigid again. Whilst the night sister was present Mrs Ratski vomited copiously and effortlessly, without retching. Sister was alarmed and called the house surgeon. The time was 5 a.m., and when he arrived only ten minutes later, symptoms of shock were very apparent, and her temperature and pulse had risen again. It all happened very quickly. The patient vomited once more, a green, bile-stained fluid, in a projectile fashion.
    The registrar was called and a quick examination was all that he needed.
    ‘This is another obstruction. Acute abdominal dilation with fluid and gas could be due to a paralytic ileus. We’ll have to get her to theatre at once. I’ll speak to Carter – and Sister, you alert theatre for an emergency abdominal.’ He turned and spoke to the houseman. ‘Give her a good shot of morphine and get naso-gastric suction going straight away. We will probably need more blood, but have some serum ready until we can get into the blood bank.’
    The registrar was at his best in an emergency – quick, confident, decisive, and, above all, commanding. He performed the operation himself. Part of the intestine was found to be paralysed and dilated with gas, and the area of the original volvulus had adhered to coilsof the large intestine and showed signs of gangrene. The sigmoid colon and the rectum were removed, and the rectal orifice closed. The colostomy, which was intended to be temporary, was now permanent.
    When Slavek visited in the evening he found his mother in the same position as she had been nine days before. The only difference was that she did not have a tracheotomy and endotracheal tube. He was deeply distressed. What had happened? He was simply told that his mother had had to go to theatre for further surgery.
    Nothing went right after that. The old lady was in a pitiable state. Two major operations and anaesthetics at her age took their toll. For two weeks she barely clung to life, but we kept her going. The gastric suction was continued for three or four days, and the drip for about a fortnight. Drugs were given by injection, because she would not swallow them. Her abdomen again filled with gas, and a trocar and cannula was thrust into the peritoneal cavity to release the gas. This was done under local anaesthetic and she was too weak to resist. Her mouth, tongue and throat were massively ulcerated long after the naso-gastric tube was removed. The self-retaining catheter had to be changed for cleansing, and she tried to resist, but was too weak to do so effectively. A urinary infection developed, so drugs were given to combat it.
    Then she developed a chest infection, so more drugs were ordered – all of which were injected. Her cough reflex was inadequate, so a physiotherapist was called in to stimulate coughing by use of exercises, palpation and postural drainage. Her heart was compromised by her weakened condition, so cardiac stimulants were given. She had been in bed for so long that she developed bedsores, which we treated two-hourly but could not prevent. The abdominal wound, after the second operation, looked as if it was never going to heal and, together with the colostomy, exuded such a foul smell that it was sometimes difficult to go near her.
    Doctors came and went. They tapped her abdomen, listened for abdominal sounds, and conferred over their findings and differing opinions.