In the Midst of Life

physiotherapist came in to try to help him to cough by palpating his chest, but this caused so much pain to his broken ribs that the idea was abandoned. With stagnant, infected fluid in his lungs, his breath became foul smelling. Pleural aspiration was ordered to drain off some of the fluid and a cannula was inserted into his lower lungs, and a little watery stuff drained away. This relieved the pressure for a while, but it did not halt the accumulation. It seemed that Dr Hyem would drown in his own bodily fluids.
    Acatheter was in place all the time, and this avoided incontinence of urine, which would have made the bedsores worse, but it had to be changed every few days, and kept clean, which was unpleasant and possibly embarrassing for Dr Hyem. Unless we cleaned his mouth every two hours with glycerine, his tongue became so dry that the skin peeled off, and ribbons of grey, stringy stuff could be pulled from his throat.
    The doctors saw none of this. Junior doctors sometimes get an idea of the suffering and humiliation that patients endure, and what nurses do, but a consultant seldom does. The more senior a doctor, the less he knows of the unpleasant details. None of this will appear in medical textbooks, which are written by academic and scientific medical experts, who spend much of their time in laboratories and libraries. Only nurses are at the bedside. And nurses don’t tell.
    The end came for Dr Hyem because his renal failure and longstanding diabetes could no longer be controlled, and acidosis developed over a few days, first with abdominal pain, and a decreased volume of urine. Then his blood pressure dropped and his pulse became thin and rapid, his ocular tension was low and his skin became very dry. The doctors decided not to attempt treatment, and he drifted into a diabetic coma from which he could not be roused.
    Dr Hyem died peacefully, five weeks after a successful resuscitation from cardiac failure.

FAITH
     
    I need no assurances – I am a man who is pre-occupied of his own soul;
     
    I do not doubt that whatever I know at a given time, there waits for me more which I do not know.
     
    I do not doubt but the majesty and beauty of the world is latent in any iota of the world;
     
    I do not doubt there are realizations I have no idea of, waiting for me through time and through the universes – also upon this earth;
     
    I do not doubt I am limitless, and that the universes are limitless – in vain I try to think how limitless;
     
    Did you think Life was so well provided for, and Death, the purport of all Life, is not well provided for?
     
    … to die is different from what anyone supposed…
     
    — Fragments from
Faith Poem
and
Song of Myself
by Walt Whitman
     

CARDIO-PULMONARY RESUSCITATION (CPR) IN HOSPITAL
     
    In 2008 I was visiting a friend who was in an acute medical ward of a large county hospital. I walked directly into the single room where I expected to find her, but she was not there; she had been moved to the main ward. In the bed was an old, old lady who looked as near to death as anyone I have seen. Her skin was as white as the sheets, her eyes sunken and rolled up towards her forehead; her cheeks were hollow, her mouth hung open, and her breathing came in ragged gasps. In my nursing days, we would have assessed that she had only a few hours to live and the ward sister would have instructed a nurse to sit beside her, just to hold her hand or to stroke her hair, or to whisper a few words now and then.
    There was not a nurse in sight. Two gently humming machines were her only companions. Monitor pads were stuck to her arms with wires leading to one machine where lights flickered and a graph line was being traced. The other machine had wires attached that disappeared under the bedclothes. An oxygen cylinder hissed continuously, and a transparent catheter was attached to her nose with sticking plaster. A saline drip running into her arm and a urine drainage bag hanging from the bedside completed the picture.
    I stood gazing at her for a couple of minutes thinking,
Poor old lady. What have you done to deserve this?
She was a total stranger to me, and I knew nothing of her medical history, but as the bed was in acute medicine, the likelihood is that she had collapsed from acute coronary failure caused by a heart attack. Someone had found her and called an ambulance, and this was the result. Nearlydead, surrounded by advanced medical technology, and not a soul around, except a