In the Midst of Life

caused congestion of the lungs, so he had great difficulty in breathing. Fluid collected in his lower lungs, creating a bubbly, rasping sound with each breath. The fluid became infected and pneumonia developed, which was treated with antibiotics.
    The back-pressure from inadequate cardiac output puts added strain on the kidneys, which were struggling to excrete the body’s waste products. Uraemia, or blood poisoning from renal failure, was kept at bay by intensified doses of diuretics.
    Back-pressure put new strain on the liver, already grossly distended and striving to cope with the rising acidosis caused by diabetes. The pancreas, the gall bladder, the intestinal tract – all of them were congested.
    Back-pressureforces fluid to leak out of the arterioles, the smallest blood vessels, into the surrounding tissues. They become waterlogged, a fluid swelling known as oedema. Ascites developed in the abdomen. Dr Hyem was totally bedridden. He sat there, day after day, with his legs, thighs, buttocks, scrotum, and belly swollen with oedema and ascites. However hard we tried, bedsores could not be prevented.
    Had back-pressure affected his brain, or was it something else? Dr Hyem hardly spoke during the last weeks of his life. When he did attempt to mumble a few words, they were slurred and barely audible. His eyes were usually closed, but when open the pupils were dilated and fixed. The resuscitation, although quick, may not have been quick enough. Small areas of the brain may have been starved of oxygen and died during the minutes that had ticked by during resuscitation.
    All the medical staff in the hospital took a great deal of interest in Dr Hyem, for open-heart resuscitation was a sufficient novelty in a small suburban hospital in the 1960s to attract attention. The registrar who had led the team became something of a celebrity. The staff all crowded around the bed, studied the notes, and regarded the machines and dials and drips with scientific interest. The cardiologist spoke to the lung specialist, the urologist to the gastro-enterologist, and the diabetic specialist to the dietician. They took brain scans (EEGs), heart scans (ECGs), recorded blood count and electrolyte balance (electrolytes were all the rage at the time), took X-rays of his chest, aspirated his lungs, measured his insulin levels and the mounting acidosis in his blood, changed his drugs, increased the changes, tried new drugs, changed them again and increased them again. They held special meetings to discuss the case; they could not have done more.
    But, as the days stretched into weeks, the doctors visited less frequently and departed more quickly. Did they just lose interest, or had the passion for progress spent itself? Was there no more scientific or biochemical excitement to be gleaned from Dr Hyem? Doctors tend to regard a dying patient as a personal failure, and frequently withdraw if the process goes on for too long. Dr Hyemwas dragging on and on. Perhaps the reality of a slow, lingering death was more than they could stomach.
    The doctors made all the decisions affecting the physical condition of Dr Hyem, but they did not see the details of what this would entail: the reality and the humiliations endured by Dr Hyem were witnessed only by the nursing staff.
    Daily hourly we treated bedsores that developed quickly because of immobility oedema and a watery diarrhoea that poured from him in the early days. The sores quickly became great, stinking holes, which we packed with flavine but which became black around the edges from lack of blood supply. The diarrhoea cleared up, and chronic constipation replaced it, which aperients and enemas could not shift, so a nurse had to remove, manually, lumps of impacted faeces from his rectum. When I read
that
in the day report, I hoped fervently that Dr Hyem’s sensitive mind had been so damaged that he was not aware of what a young nurse was doing to him.
    Spoon-feeding a little semi-solid food was always difficult, and was frequently regurgitated, trickling out of the corners of his mouth, over which he had no control. The amount of food and fluids and the quantity of glucose in the drip had to be monitored all the time, and balanced against his insulin injections to control his diabetes.
    His breathing was always laboured and painful to see. His cough reflex was seriously depressed and he could not bring up the sputum that collected in his lungs. A frothy exudate bubbled from his mouth sometimes. A