In the Midst of Life

another cause, found that fifty-five per cent of people who died of the condition, died with a feed-peg or a naso-gastric tube in place. **
    In January 2010 a report on
Oral Feeding Difficulties and Dilemmas
was published by the Royal College of Physicians, together with the British Society of Gastroenterology, and endorsed, among others, by the Royal College of Nursing. This presented the results of a three-year study under the chairmanship of Dr Rodney Burnham. It reports that thousands of old people are being forced to have feeding tubes implanted in their stomachs if they need to be admitted to a nursing care home, and that this is a widespread problem, because many care homes say they will not take a patient until they have had a gastrostomy.
    The report states that the practice of force-feeding old people through tubes in their stomachs is seldom necessary, is highlyinvasive and should not be undertaken lightly. Critics have questioned the Royal College of Physicians’ findings and pointed out that only a doctor can decide whether a person should be subjected to a gastrostomy, to which the RCP replies that there is pressure on doctors to authorise it in order to free up hospital beds by discharging patients into residential care.
    Why is this practice ‘widespread’? Why do nursing care homes only accept a patient with a gastrostomy? The answer is that it will take a carer fifteen to twenty minutes to spoon-feed a patient adequately, whereas it takes about two minutes to pump a semi-liquid feed into a stomach. Drugs can be administered with the same speed and efficiency. Time is money, and the advantages are obvious.
    We, the general public, are responsible for this. We are paranoid about not letting anyone who cannot feed himself die quietly as nature intended. Without knowing it, we push for force-feeding of old people.
    Wherever they meet, nurses talk shop. On a walking holiday in Italy I met Sandra, an American nurse from Florida. It was May 2009, and my mind was full of the book I was writing, so I mentioned it. Her face changed from mild interest to focused attention, and her voice became urgent.
    ‘Oh my God! This book has gotta be written. We do it all the time. Hell, it’s crazy. We dialyse people who are ninety-eight per cent dead. They don’t know anything, can’t move, can’t swallow, can’t talk, totally incontinent, an’ we do renal dialysis, three times a week. Hell, it’s just crazy.’
    ‘Can you go on?’ I asked.
    ‘I tell you, we got a guy in our clinic at the moment with creeping paralysis – it’s got a lot of new fancy names, but it’s the same ol’ thing, creepin’ paralysis – starts in the peripheries an’ creeps up through the body, an’ when it gets to the lungs that’s it. Or it used to be. But not any more. This guy’s had it for two years, slowly, slowly losing all sensation an’ control, creeping slowly up, an’ it’s got to his lungs. So what do we do? Eh? We bring in a respirator. At the same time he loses control of swallowing – so wepass a naso-gastric tube. It’s obscene.’ She had to pause before continuing and her voice became slower and sadder. ‘Poor ol’ guy, he was so sweet. It alters y’nursing perspective, y’know. When you’re looking after someone with Alzheimer’s or creepin’ paralysis, you build up a real relationship, with a real person. When it gets to a respirator and artificial feeding, you’re just maintaining a machine, and the person gets to be a chemical reactor. It’s not the same at all.’
    The sunshine suddenly seemed less bright, and the Bay of Naples less beautiful.
    ‘Do you think profit is the motive?’ I asked.
    She shrugged. ‘Your guess is as good as mine.’
    ‘When will it all stop?’ I enquired.
    She was fierce in her reply.
    ‘I’ll tell you. It’ll stop when the money runs out. When relatives have to pay for it out of their own pockets. When they can’t demand that the insurance pays for it.
That’s
when it will stop.’
    ‘When the money runs out’! Great poets and writers and thinkers can express the inexpressible, and see way into the future. Samuel Beckett, in his book
Malone Dies,
published in 1951, wrote, ‘There’s no place in America where a man can die in peace and with some dignity, unless he lives in abject poverty.’
    The possibility of extending life for long periods of time opens the door to exploitation, and I have a hunch that it’s possible a good many people might be