In the Midst of Life by Jennifer Worth
They both laughed, and saliva trickled from the side of her mother’s mouth. Maggie tenderly wiped it away, and kissed her mother. She whispered, ‘We’ve had such fun, haven’t we, Mummy darling, and we’ll have fun again when you come out of hospital. I’ll always be there to look after you.’
Priscilla arrived the following day. She was tall, slim and dignified. Her features were composed as though nothing could ruffle her, and her nostrils were very close and narrow, which made her appear to be sniffing slightly all the time, an effect intensified when she pursed her lips and raised her eyebrows.
In spite of her apparent composure, Priscilla was very tense and ill at ease. A hospital was quite outside her experience; she was no longer in control. Before she had even seen her mother, she asked to speak with the consultant. I said that Miss Jenner was in theatre all morning, and had a clinic in the afternoon, and that I did not expect to see her on the ward that day. Her nostrils contracted and she said in a clipped, precise voice, ‘Please inform Miss Jenner that I am residing in London for a limited period and that I request an interview at her earliest convenience.’ I said that I would do so, and did she wish to see her mother? She replied, ‘Yes, of course.’
I led her to the side ward. Two nurses were there. They had washed Mrs Doherty and changed her nightie and managed to get her out of bed to sit her in a chair. One of them was on her knees on the floor, adjusting Mrs Doherty’s feet to rest on a footstool; the other was tying a bib round her neck to catch the saliva as and when it dripped. Her body slumped to the right, in spite of the pillows they had placed to try to keep her upright, and she looked up as best she could by moving her head and raising her left eye a fraction. She obviously recognised her daughter, because a gurgling sound came from her throat and she moved her left arm in greeting.
Priscilla did not say a word. I opened the window a little, and one of the nurses looked at me questioningly. Should they attempt to give Mrs Doherty her morning drink? We understood each other without a word being said – this woman was undoubtedly intimidating, and would probably be critical. To attempt to give a drink to her mother, even from a feeding cup, would probably be repellent to her. No morning drink. Not yet, anyway.
One of the nurses placed a chair beside Mrs Doherty. I asked Priscilla if she would like a cup of coffee, but she shook her head. She still had not spoken. We left the room and shut the door.
Five minutes later she came out and asked to see me. The confidence, the assumption of superiority, had been knocked out of her.
‘This is a bad business, Sister.’
‘Your mother has had a severe stroke, which is always distressing to see.’
‘I was not aware it would be as bad as this.’
I refrained from saying that she did not look nearly as bad as she had a fortnight earlier. Instead, I said, ‘Your mother is making progress as well as can be expected.’
She turned suddenly, almost angrily. ‘But she cannot speak!’
‘No.’
‘She can only make gurgling noises.’
‘The side of her brain controlling speech has been affected.’
‘Well, what are you going to do about it?’ she demanded.
‘There is very little we can do, apart from physiotherapy, to encourage the healing powers of nature.’
‘Healing powers of nature! Is that all you are doing? There must be some drugs she can have. What about all the miracles of modern medicine we hear so much about?’
I thought how the miracles of modern medicine can prevent someone dying from a stroke, but cannot restore the loss of speech nor the loss of muscular control that are its legacy.
‘I must see the consultant. I must discuss what can be done about this distressing situation.’
I was explaining again that Miss Jenner was not expected on the ward until the following day, when I heard a familiar voice in the corridor. ‘Excuse me a moment,’ I said, and went out. It was Miss Jenner.
‘Hello, Sister. We closed theatre earlier than expected, so I thought I would just pop down to see how Miss Patterson is getting on. Perhaps that drain can come out. And if you can find a cup of coffee, that would be nice.’
I told her that Priscilla, Mrs Doherty’s eldest daughter, was in the office and wanted to speak to her.
‘I’ll see Miss Patterson first, then have a chat with her.’
A little later, before we parted for lunch, I caught up with Miss Jenner, and she told me what Priscilla had said. ‘She seems to think that we can restore her mother’s speech and movement by drugs. It astonishes me, the ignorance of the most fundamental medical facts that intelligent, well-informed people sometimes display.’
‘Very true,’ I laughed.
‘She seems to think that because we have not already done so, we are being negligent, and have missed an obvious point.’ She shrugged her shoulders despairingly. ‘I don’t know what she thinks we should be doing, but she is demanding another medical opinion.’
‘And will you get one?’
‘Well, I shall have to get a geriatrician’s assessment for her mother. She can’t stay here indefinitely. This is an acute surgical ward. She will have to go to the geriatric ward. That will give her daughter the second opinion she requires.’
Miss Jenner sighed deeply. She was a lady in her fifties, about twenty years older than I was.
‘It used to be so much easier in the old days. When I was a medical student it was not expected that anyone would survive a massive cerebral haemorrhage. All the medical textbooks, all the lecturers, informed us that death would result within a few hours, or at most a few days.’
‘I doubt if anyone would say that now.’
‘Oh no!’ Miss Jenner said emphatically. ‘No one would dare to say such a thing. They would be in serious trouble. It is a very dangerous subject.’
Miss Jenner left, and I sat very still at my desk, my mind going back about twelve years. Miss Jenner had used exactly the same words that Matron Aldwinkle had used when I was a student nurse – ‘This is a dangerous subject.’
A FAMILY DIVIDED
The geriatrician came to assess Mrs Doherty and advised a rehabilitation centre. Miss Jenner said that the patient could not remain for long on the acute ward, and asked if a bed could be found on the geriatric ward until rehabilitation. It was not easy – there were too many patients and too few beds available. The consultants both knew the difficulties. ‘We’ll ask the medics. They have more of a turnover than we do.’ The medical registrar came to see Mrs Doherty and said that a patient with colitis would be discharged at the end of the week and a bed could be available.
Miss Jenner saw Priscilla and told her that two specialist opinions had been sought and that her mother would be transferred to a medical ward for treatment for the aftermath of a stroke. Following on from this, her mother would go to a rehabilitation centre. The woman seemed satisfied with this and said, ‘I will reside in London until next week, and then I must return to Durham.’ Then she said, very formally: ‘On behalf of my family I would like to thank you, Miss Jenner, for saving my mother’s life. You obviously acted with great skill.’
She turned to leave and had to pass her mother’s door. She put her hand on the handle, and paused. One could almost feel the indecision going on in her mind, her sense of duty telling her she should go in, yet opposing that, her fear of seeing her mother, of not knowing what to do or say. She half turned the handle, then released it, and started to walk away. At that moment Maggie came round the corner with an armful of flowers.
‘Priscilla! You old stick! You didn’t tell us you were coming in this morning. How is she?’
Priscilla hesitated before answering. She looked exceedingly discomfited, and then said truthfully, ‘There is no change.’
‘But is she awake? Was she glad to see you?’
Priscilla could not answer. Her nostrils closed to narrow slits and her shoulders tensed.
‘Priscilla!’ Maggie was furious. ‘You are i
‘Don’t make a scene here in the corridor, with everyone listening.’
‘I don’t care if the whole world can hear me! Dear Mummy, lying there ill, and you don’t want to see her.’
‘Stop this behaviour. We will go in together.’
She opened the door, and they entered. The staff nurse and I looked at each other.
‘Wow, that was a near thing!’ she said. ‘We don’t want them fighting here in the corridor. You see it all in this life, don’t you, Sister?’
I could only agree.
We had a busy morning. There were five cases for theatre. That meant preps and pre-meds, calling the porters, arranging for nurses to escort patients to theatre and, afterwards, back to the ward, post-ops to be received and cared for, and student nurses to be taught the details of post-operative nursing. I was thankful to have a very good staff nurse, who was highly experienced and loved the drama and excitement of an acute surgical ward. She was indispensable on such a morning.
We had almost forgotten about Mrs Doherty when suddenly Maggie came screaming out of the side ward. ‘Sister, Sister, come quickly. Something’s happened.’
The staff nurse was there before me. She said, as I entered, ‘I think it’s another stroke. I’ve called the doctor, but of course our team is in theatre. One of the medics will come.’
One look was enough to confirm Staffs assessment. Mrs Doherty had slithered from her chair, and was slumped on the floor. Her eyes were wide open, but her pupils had receded upwards, and only the whites were showing. Her mouth, hanging to the right side, was open, and copious frothy fluid poured from it.
Maggie was sobbing and holding her mother in her arms. Priscilla was leaning against the wall, her face as white as a sheet. She was struggling to control her breathing, and her eyes were staring horrified at her mother.
‘My God, we are going to have two strokes on our hands, if we are not careful,’ I thought, and went over to her.
‘Would you please go to the office and ring your brother, Jamie? Tell him to come, because this looks serious.’ Giving someone in a state of shock a job to do is usually the best way of dealing with the situation.
I whispered to a nurse, ‘Go and ask the ward maid to make some strong coffee for that lady. She’s going to need it. Then prepare a lumbar puncture trolley.’
Two porters were just entering the ward to take the next patient to theatre. It was fortuitous. I called them in to help us lift Mrs Doherty on to the bed and shortly afterwards the medical registrar arrived. She said, ‘We must sedate to stop these muscular spasms, then I will do a lumbar puncture.’ I said that the trolley was ready. We turned the patient, and doctor inserted the long needle between the third and fourth lumbar vertebrae. The fluid draining out was heavily bloodstained. ‘We can assume another haemorrhage. This patient belongs to your team, not ours. She must be seen by Miss Jenner.’
Maggie was in the room – she refused to leave her mother – and asked how long that would be. I said that Miss Jenner was in theatre and the list was due to finish at 1 p.m. It was then 12 noon. Mrs Doherty was deeply unconscious, breathing noisily and very slowly. Her pulse and blood pressure were very low. I thought, This is it. She won’t survive this one, and said to Maggie, ‘We must keep your mother very quiet. I am sure you will want to stay with her.’ She nodded tearfully.
In the office, Priscilla was looking a bit better. She said that her brother Jamie was on his way and that they would see Miss Jenner together.
Jamie arrived at about 12.30. Theatre closed slightly ahead of time, and Miss Jenner came straight to the ward, still in her theatre clothes. I accompanied her into Mrs Doherty’s room and Jamie and Priscilla joined us.
Miss Jenner examined her patient and said exactly what the registrar had said: ‘A second cerebral haemorrhage has occurred.’ She said no more. Maggie sat by the window, crying quietly. Priscilla stood by the door, looking tense. Jamie stared at them both, and said:
‘I don’t think any further treatment should be attempted.’
Maggie sobbed quietly. ‘But she will die, Jamie,’ she said in a tiny voice.
‘She will, and it will be for the best.’
‘How can you say that? For the best! What a wicked thing to say. Our darling Mummy!’ Her voice was rising.
The accusation stung. ‘I’m not wicked. I’m being realistic.’
‘I hate you. Realistic! At such a time!’
‘Don’t create another scene, Maggie,’ interrupted Priscilla.
‘You cold fish,’ she shouted. ‘I suppose you want Mummy to die also – then you won’t have to come and see her. Is that it?’
‘I decline to answer. You are getting hysterical again.’
‘I’d rather be hysterical than cold and heartless like you two.’
Miss Jenner and I looked at one another. This was not the time or the place for a family row. Miss Jenner turned to Maggie and said gently: ‘Your brother is probably right. The time has come to let go, and allow your mother to die in peace.’
Maggie looked up with unspeakable anguish.
‘Let go? She is all I have. She was getting on so well – almost talking to me. I was beginning to understand what she was saying, and she understood every word I said.’
Maggie sobbed quietly into a wet handkerchief, and Jamie gave her his, and put his arm around her. No one spoke for a moment, and between sobs she continued, ‘I’ve been getting the downstairs room ready for her – it’s all so pretty, just as she would want it.’ She looked up at Miss Jenner. ‘Is there nothing you can do?’
Miss Jenner did not answer. The silence in the room was tense. The sound of stertorous breathing from Mrs Doherty seemed unusually loud.
Then Priscilla spoke. ‘Is there anything you can do to relieve my mother’s condition, Miss Jenner?’ Her voice was precise, and demanded an answer.
‘I could do another cranial exploration,’ she said quietly.
‘Then it must be done.’
‘No,’ said Jamie, ‘I won’t allow it. She has gone through enough already.’
‘It must be done,’ Priscilla retorted.
‘Why? In God’s name, why?’
‘Because it can be done,’ Priscilla said.
‘I do not advise it,’ said Miss Jenner. ‘I cannot be confident that she will survive a second operation.’
‘There you are, Priscilla,’ Jamie said, ‘Medical advice is against operation.’
Priscilla ignored him, and spoke to Miss Jenner.
‘Will she survive without operation?’
‘It is unlikely. In fact, I must answer no, she will not.’
‘When is her demise likely to occur?’
‘That is more difficult to predict.’
‘Days? Weeks?’
‘Oh no, not weeks. Maybe later today, or during the night.’
Maggie screamed, ‘No, oh no, no, please!’
‘So the balance in favour of survival is to operate?’
‘Yes, it is.’
‘Then it must be done.’
Jamie confronted his elder sister. ‘I don’t agree, and I will not give my consent to operation.’
‘Your consent will not be necessary. I will give mine.’
Maggie jumped up, her tears stopped, her face hopeful.
‘Oh Priscilla, you’re wonderful. Can it be done, Miss Jenner? Can you save Mummy?’
‘I cannot guarantee it.’
‘But you can try, can’t you? And I will look after her when she leaves hospital. I want to look after her.’
Jamie was exasperated. ‘You just want something to fill your empty life.’
‘Don’t be so beastly. You just want her out of the way.’
Miss Jenner interrupted. ‘Please. You can settle your differences elsewhere.’
Jamie looked furious. ‘I don’t want her “out of the way”, as you put it. I just want what is best for her.’
<
She turned to Miss Jenner. ‘Please, oh please try’
‘I cannot guarantee a successful outcome, and therefore I am reluctant to operate,’ the surgeon said.
‘What is the balance in favour?’ asked Priscilla.
‘I would say about fifty-fifty Not more.’
‘Then it must be attempted.’
‘No,’ said Jamie, ‘It would be going too far. Why are you so keen on a second operation, Priscilla, when it is against medical advice?’
‘I am not “keen”, as you put it. I merely say that if an operation can relieve the pressure on her brain and save our mother’s life, then it must be done. To do nothing, and allow her to die, would show indifference or negligence, which I cannot allow.’
‘Priscilla, you are so sensible. We must do all we can for Mummy.’ Maggie turned to Miss Jenner. ‘Don’t listen to Jamie. He doesn’t understand. We can’t just allow Mummy to die.’
Miss Jenner replied, ‘Your mother is going to die anyway. An operation will only delay death.’
‘That’s what I’ve been trying to say, Maggie, only you won’t listen. And it’s the reason why I don’t think it should be attempted. We must do what’s best for her. I appeal to you, Miss Jenner.’
‘Be quiet, Jamie. Don’t listen to him, Miss Jenner.’ Maggie was sobbing again. ‘Mummy could get better. It’s quite possible. She has been improving every day this week. I have seen it. She can nearly talk – at least, I can understand her, even if you can’t. We must do all we can for her.’
Priscilla spoke again. ‘If a second operation holds any chance of survival, then it must be done. I cannot have it on my conscience that, when my mother was seriously ill, I stood by and did nothing. I am not even sure about the legal rectitude of non-intervention.’