In the Midst of Life

from within, and when I entered, I saw that it was coming from Dr Hyem’s bed. The curtains were drawn, but brilliant light was shining and half the men in the ward seemed to be awake.
    I pulled aside the curtains and found a full-scale open-heart resuscitation being carried out by three doctors, one of whom, the registrar, had a scalpel in his hand.
    Dr Hyem was lying flat on his back. His chest had been cut open on the left side, from the sternum to the lower back ribs. Blood was oozing out, and the smooth chest muscle was glistening in the bright light. Rooted to the spot, unable to breathe or make a sound of protest, I watched the registrar with a swift, easy movement slice through the pleural muscle, revealing the ribs.
    ‘Retractor,’ he demanded.
    I found my voice. ‘No! No! What are you doing? Stop! Stop it, I say!’
    He ignored me. He inserted the retractor between two of the ribs, and turned the ratchet to open the double arms of the instrument to their full potential. I heard a rib crack.
    ‘Stop it!’ I shouted.
    Perhaps he had not heard, as he continued with the ratchet, and I heard a second rib crack.
    ‘Scissors,’he demanded.
    By then I was getting close to hysteria. I took a couple of steps forward.
    ‘What are you doing? Stop it. He’s dying – can’t you see that? Leave him alone.’
    The doctor was cutting through the pericardium with surgical scissors. He muttered, ‘Who the devil are you? Get to hell out of here.’
    He inserted his hand through the open chest wound and grasped Dr Hyem’s heart; then he began a series of steady, firm compressions.
    There was blood all over the place, dark venous blood, black and sticky, covering the doctor’s white coat, and the sheets and pillows scattered across the floor.
    ‘It’s fibrillating badly, but at least there’s some movement,’ he said as he continued his compressions. ‘How long have we been at it?’
    ‘Two minutes twenty,’ replied one of the housemen.
    ‘Not bad. If we keep it up, we should win. Here. You take my place. Then you will know what to do next time.’
    He withdrew his hand and stepped backwards. One of the others took his place and inserted his hand through the hole in the chest wall.
    ‘Can you feel the heart?’
    The young man nodded.
    ‘The ventricles fibrillating, like a jellyfish wriggling?’
    Again the houseman nodded.
    ‘You can? Good. Now just squeeze the lower myocardium – regular – firm – steady; one squeeze about every second. That will force the blood upwards, out of the ventricle into the upper chamber and into the circulation.’
    This was obviously a teaching exercise.
    The older man stood up and stretched his back. He wiped his bloody hand down his coat.
    ‘That was good,’ he said with satisfaction. ‘We are winning. I can feel a pulse in the jugular.’
    Thensomething spine-chilling occurred. Dr Hyem, lying flat on his back, opened his eyes and stared into the brilliant light shining directly on him. His mouth hung open, and a rasping roar was emitted from the depths of his throat. It was a ghastly noise, like the whoop or howl of an animal in agony. The sound rose to a crescendo and then stopped abruptly, and the silence that followed was almost more dreadful than the roar.
    I ran around to the other side of the bed and took Dr Hyem’s head and shoulders in my arms in a futile attempt to protect him. He looked at me, I swear he looked at me, and in his eyes was reproach. He had said, ‘When my time comes I want it to be the end. I don’t want anyone messing about with me.’ I had promised that he would die peacefully, and I had let him down.
    I have lived with that look of reproach all my life.
    ‘I told you to get out of here, woman. Now clear off and don’t interfere,’ barked the registrar.
    ‘I am the night sister,’ I exclaimed, ‘and Dr Hyem is in my care!’
    ‘Bloody fine care you give, trying to be obstructive.’
    Then to the team, ‘He’s coming round. Excellent. Ah! There’s the porter with the machine. Splendid. Bring it over here.’
    He spoke to the two younger doctors. ‘Fix it up, and it can take over the massage. Now, we will want a central line through the iliac vein, and another in the subclavian, but try the iliac first, and a shot of adrenaline direct into the myocardium. Get a tracheal tube down him, and fix up the oxygen supply.’
    Then again, to me: ‘Look, I told you to clear off.’
    ‘I am the night sister.’
    ‘I don’t care if