In the Midst of Life

by Jennifer Worth

  Leah spent three or four weeks in the orthopaedic unit of the main hospital. This is much longer than most people stay, but she could not remain indefinitely because the bed was needed for emergencies and she was transferred to what one would call a long-term geriatric hospital. My heart grieved for her when I heard where she was going, because I knew the hospital, and it did not have a good reputation locally. That was, I think, because the buildings had formerly been the old workhouse infirmary, and they had a bleak and forbidding aspect – ‘Abandon hope all ye who enter here.’ I approached the place with trepidation.

  As I found my way to the ward, my attitude changed. A pleasant young nurse directed me to Leah’s bed and several others smiled at me as I passed. Leah was just finishing her lunch. I saw that her head was bent over and her shoulders were shaking. I thought she was crying. With great concern I touched her shoulder and said, ‘Whatever is the matter, Leah?’ She looked up and at once I saw that she was not crying, but laughing!

  ‘I was just thinking about yesterday’s lunch. Pass me those tissues, will you dear, and I’ll tell you what happened.’

  She blew her nose and wiped her eyes.

  ‘The ambulance came to bring me here. Well, I was in the back with a young man and we got talking. He was South African, so I told him that I had been there with my husband when he was working on the film Gold with Roger Moore and Susannah York. And would you believe it, it turned out that his father was a stunt man in Gold. Well, we had so much to talk about, swapping stories, and he was telling me about his family and how his father came to be in Gold, that we didn’t notice time passing. This hospital is only about a mile up the hill from the main one, but about half an hour had gone by. We had travelled fifteen or twenty miles, and neither of us noticed.’

  She had to have a little cough and wiped her eyes again before continuing.

  ‘Well, we got to the hospital and they lifted me out and carried me up to the ward. A nurse showed them the bed that was ready for me, and they tucked me in. Another couple of nurses made a fuss of me, checking to see I was comfortable, and then the nice young South African boy said goodbye.

  ‘It was nearly lunchtime, so they brought me lunch, which I ate, then they cleared it away, and I was just settling down for a little doze when a young lady doctor came over with a bundle of notes in her hand. She said she wanted to examine me, and pulled the screens around the bed.

  ‘Well, she examined me all over, eyes and throat, and heart and lungs and I don’t know what, then she looked at my leg and said, “This is a very long plaster for a fracture in the foot.”

  ‘“No, it was the tibia and fibula, a compound fracture.”

  ‘“It says here, the fourth metatarsal.”

  ‘“Well that’s wrong, it was the tibia and fibula.”

  ‘“I’ve got X-rays here, Mrs Wilson, and—”

  ‘“But I’m not Mrs Wilson!”

  And then it all came out. No one knew quite how it had happened, but the ambulance men had been given the wrong instructions. The hospital was expecting a patient, and a bed was ready, so I was put into it, no questions asked.’

  She had to cough again, she was laughing so much.

  ‘So I had to be transferred again. I didn’t get here until yesterday evening. I’ve been wondering about Mrs Wilson and what sort of a day she had. Mine was highly entertaining.’

  In all the weary months that followed, Leah’s sense of humour never deserted her, and her interest in life never flagged.

  From the beginning, Leah had been on continuous urinary drainage, because it would have been impossible for her to use a bedpan regularly. A catheter into the bladder for weeks on end can cause friction and general discomfort, but she did not complain. I presumed that she was having diuretics to keep the kidneys functioning efficiently, and also some kind of anti-bacterial drug to avoid infection.

  I do not know what happened to her bowels. From experience I can say that bowel movements can be one of the biggest problems for geriatric nurses to have to deal with. Constipation usually sets in, and faeces become impacted, leading to nausea, headaches, lethargy, confusion and other nasty conditions for the unfortunate patient. Enemas help, but Leah could not have been turned on her side to receive an enema. Aperients often add to the abdominal pain, or can sometimes cause uncontrollable defecation into the bed, causing a nightmare of shame and humiliation for a sensitive person. How the nurses and carers handle this is one of the greatest challenges of good practice; a bad experience can leave a scar, slow to heal, on the mind of the unfortunate patient.

  Weeks passed, and the leg did not heal. I don’t know how Leah endured the boredom of those long summer months, trussed up in a massive plaster that was impossible to move. Sometimes she complained of aching and stiffness in other parts of the body, so I massaged her other leg and her back and shoulders, which she said helped. Thank God for those new air beds, I thought, which continuously shift pressure from one part to another. In my nursing days massive pressure sores would have developed.

  About six weeks after admission, Leah complained of a slight cough, which she could not shift. The next time I saw her she looked dreadful. It was an embolism in the lungs, I was told. She was on high doses of antibiotics and continuous oxygen and an intravenous drip for fluids. She could scarcely open her eyes or move a hand. Her breathing was laboured, yet she had the courtesy to mouth the words: ‘I can’t talk. Forgive me.’ I sat quietly massaging her upper chest for about an hour. ‘This is it,’ I thought, ‘she won’t survive this one.’

  From the beginning, when the fracture first occurred, she had been on cardio-vascular drugs and other drugs to maintain circulatory function, as well as diuretics to stimulate the kidneys. When the embolus lodged itself in the lungs, massive doses of clot-busters were added, and all the other drugs were modified or intensified. Daily blood samples were taken for analysis until, she said, she felt like a pincushion.

  Leah was on the ‘not for resuscitation’ list, which meant that, if she actually died, no attempt at resuscitation should be made. In my days of nursing, an embolus on the lungs would almost invariably have been fatal for an old person, and I felt reassured to see that notice at the end of her bed. I was glad to see that she would be left to die in peace.

  I was not the only one to expect her death from an embolus. Her granddaughter, who was a practising nurse in Israel, came over to England and stayed in Leah’s flat, spending most of each day at the hospital with her grandmother. But the antibiotics, the oxygen, the clot-busters and the drip, combined with the cardio-vascular drugs, did their work. Leah was tougher than anyone had imagined and confounded us all. Two or three weeks later she was as perky as ever, sitting up in bed knitting or sewing, doing the Times crossword puzzle, watching Countdown, Mastermind and University Challenge on TV, getting most of the answers right, and beating me at Scrabble.

  At some point during the summer months she developed an infection of the lungs. ‘It’s an MRSA bug,’ I thought, ‘this will be the end.’ But it was not the dreaded MRSA. It was a treatable infection, and another course of antibiotics drove it away. Leah was back on form – on form for her visitors, that is. None of us knew what she really endured as the weeks dragged on into months.

  A long-stay geriatric hospital is not a place where any of us would like to end up. Leah was in a smallish ward of fifteen beds that were not too close to each other, but close enough for there to be no privacy. Most of her neighbours were confused in one way or another. Yet Leah never complained, not to me, at any rate. She did not become morose, in-turned or whiny – least of all did she succumb to self-pity. Her thoughts were always focused on those around her. ‘Look at that poor old soul over there. She cries all the time, poor soul.’ Or, ‘That woman over there came in last night. Her son came with her, a man of about fifty. He stayed all night, but he went after breakfast, had to go to work. It was good of him to stay for so long, don’t you think?’

  The ward was chronicall
y understaffed, and the nurses and care assistants were under great pressure, but they were cheerful and tried to maintain a happy atmosphere. Leah liked them, and knew all about their boyfriends, their children and their holidays. She was obviously popular. The worst thing for her was the boredom – ‘There’s nothing to do. The day is punctuated only by meal times, nothing else.’ Leah continued with her crosswords and books and knitting, which she adored, and I often took her a new commission to be knitted for someone else. Another friend, Suzy, had seen the same need, and also presented her with things to be knitted, until Leah had to draw a line – ‘Nothing more till after Christmas. I can’t cope.’

  Leah’s reading would have been impressive for a woman half her age, but for someone of one hundred and two it was formidable. Moreover, she read without the use of spectacles. I saw her reading in hospital a history of Afghanistan in the twentieth century, upon which she commented knowledgeably; a biography of Charlotte Bronte, with a second for comparison; she read novels, biography, social history, poetry and occasionally a newspaper, but never a magazine. ‘I can’t waste my time on those things,’ she said.

  She made the best of things with heroic goodwill, but it was not easy. ‘Nights are the worst,’ she said to me once. ‘I hardly sleep. Nights are very long.’

  I am sure they were. To be awake, uncomfortable, and scarcely able to move for hours on end must have been a torment. I asked her about getting a nurse to shift her position.

  ‘There aren’t any nurses overnight,’ she said. ‘Well, not what I would call a nurse. There are all these different women who come from an agency. You never see the same one twice, and they are so slow. I don’t know what they are supposed to do. They amble around, or sit chatting, but you can’t ask them to do anything, because they won’t.’

  I thought of my own months of night duty as a student nurse, when we were constantly on the move in a ward of thirty beds.

  ‘But what about the night sister?’ I said. ‘You could ask her to get the nurses to move you.’

  ‘I haven’t seen a night sister since I’ve been here,’ she said simply.

  The ward was hot and claustrophobic, but the summer wore itself away and autumn brought with it cooler weather, which was a relief. Many times X-rays had been taken, but, to Leah’s disappointment, each time they showed that the leg had not healed and the huge plaster could not be removed. She would have to stick it out.

  In November, after five months of discomfort and immobility, it was finally taken off and a knee-to-ankle plaster was fitted. She was overjoyed, and when the nurses brought her a Zimmer frame, she practised walking with the zeal of a young athlete training for the Olympics. Finally, she went to a rehabilitation centre where, to her delight, she had a room of her own. There was a high staff/patient ratio there, and she had a lot of physiotherapy. At last, the short plaster was removed, and life skills were introduced, such as walking up and down stairs, taking a bath and shower, using the kitchen, cooking a meal. She was determined to succeed, and within a fortnight, after six weary months in hospital, Leah was ready to go home.

  Leah was treated entirely by the National Health Service, and from my observation as a visitor, I would say that she received good treatment throughout. The ambulance emergency treatment on the night of the break was impeccable, and the fact that she survived was little short of a miracle, and due entirely to her hospital care. Having been trained in the old school of nursing, when discipline was rigid, I was a bit shaken by the free-and-easy attitude of the nurses, but I think that is just my age – everything has loosened up in the last fifty years, and no one today would put up with the sort of nonsense that manacled us young nurses. There was, undoubtedly, a relaxed and cheerful atmosphere generated by the nurses. They sat on beds, chatted and laughed with the patients – things we would never have dared to do. I had the uneasy feeling, though, that no one seemed to be in charge, and I discussed this with Leah.

  Leah agreed. ‘I’ve been in several different wards, both here and in the main hospital, and I could never have told you who was in charge.’

  The main hospital was superior in every way to the long-stay geriatric hospital. But this has always been the situation. There is no point in looking back sentimentally and moaning, ‘It was better in my day.’ because it was not. The drama and excitement of surgery, acute medicine, emergency care, have always been the aspects of medicine that have attracted staff, and the career structure of the professions reflects this. An ambitious young doctor or nurse will rarely go into geriatrics if he or she wants to get on in the profession.

  On the whole, I would say that things are probably better today than they were half a century ago. Staff shortage is no less acute, but at least Leah was in a ward with only fifteen other patients, and there was a reasonable distance between each bed. In my day, wards contained between thirty and forty beds, with about two foot of space between them.

  Leah spent about four months in the geriatric hospital. In general, she was treated with kindness, courtesy and professionalism. The weariness and boredom of her situation she coped with in her own way, through mental activity and engaging with staff, who seemed to go out of their way to keep her spirits up. Quite simply, they were good to her.

  2008

  HOMECOMING

  Leah was discharged in December under the care of her GP, a district nurse and a home help. She occupied a beautiful ground floor flat in a large Victorian house that was divided into twelve. She was the oldest resident and everyone knew and liked her. Something akin to a reception committee was waiting in the hall to greet her when the ambulance brought her home. She was thrilled, and not a little touched, by all the attention.

  However, she was basically alone, and had to manage. Indeed, it was what she wanted, as she was fiercely, almost aggressively, independent. Her grandson begged her to come and live with them in Israel, but she refused. It was pointed out that she could afford to pay a carer to live in for a while. ‘I should hate it,’ she replied. ‘I have to learn to manage by myself.’ And slowly and surely she did. Every step with the Zimmer frame was tortuous, every turn to get something from a cupboard or the fridge was frightening to watch, but she wouldn’t let anyone do it for her – ‘I’ve got to do it myself,’ she said. The neighbours, Suzy and Sandy, and her cousin, Carmela, did the shopping for her, and brought in cooked meals.

  Predictably, the home help didn’t come up to scratch. ‘She just flicks a duster around the place, doesn’t do anything properly, but I suppose I will have to put up with her until.’ I can do it myself And once, ‘I was disgusted! I gave her my sheets to iron. I had washed them’ – and she had, God only knows how – ‘and she only had to iron them, and put them on the bed. When I went to bed that night, would you believe it, I found that she had only ironed the top and bottom of a folded sheet, and not opened it out to iron the middle. I have never been so disgusted in all my life! I had to get up at 11 o’clock, take the sheets off the bed and iron them myself. I will never give her sheets to iron again – never.’ The thought of Leah stripping a bed, manipulating an iron and ironing board whilst clinging to a Zimmer frame, then making the bed in the middle of the night, sent a shiver down my spine. But I kept very quiet on that one. I have never ironed a sheet, to my recollection. My attitude is – if you can’t give a thing a shake and put it on the bed it’s not worth keeping! But I could hardly say that, could I? I didn’t want to end up in her ‘disgusted’ book.

  Her social life intensified. She couldn’t get out, so people came to her. She revived her former bridge parties, and played with ferocious zeal, I was told. Bridge is a very difficult game, requiring a quick mind and memory skills. I resigned myself to being wiped off the Scrabble board, although she had the kindness to tell me my game was improving. I found, to my surprise, that I was concentrating fiercely, working out all sorts of sly strategies to outmanoeuvre her, but I never did, she was too quick for me. Then I realised, not at all to my credit, that I was getting irritated
, and was determined to beat her. But the craftier I became, the more did she, and she was always one step ahead. Incidentally, she also kept the score, adding it up in her head as we went along. I tried score keeping once and got into such a muddle that she took the task from me without a word.

  Steve and Sandy were very good to her, coming in each day to see if she was all right and if she needed anything. They had a baby who was between a year and eighteen months old at that time, and they brought him in to visit her every evening when he’d been bathed and was in his pyjamas ready for bed. Some toys were kept in Leah’s flat so that he could play. The two seemed to love their time together, and I have seen that little boy in the hallway, crawling towards her flat and lifting his hands up towards the door. Even after she had gone, he continued to do this for several months.

  In February, Leah had her 103 rd birthday. The whole family, including great-grandchildren, came over from Israel. The flat was so full of flowers you could hardly move.

  Leah was determined to do more things for herself. She started by walking one hundred yards down the road and back, unaided. The next thing we knew she had been to Tesco, which was a quarter of a mile away. ‘I like to choose my own things. I don’t like people shopping for me – they always get it wrong,’ she said. In early March she said, ‘I’ve been up to the Town Hall today to get my bus pass. I will need it when the weather gets better.’

  Then the ceiling fell in the bathroom. It sounded like an explosion. No one was hurt, but it broke the wash-hand basin into two pieces and cracked the lavatory pan. It would have been a shock to anyone, but Leah took it in her stride, and in the end my sympathies lay with the builders and the insurance men; the stick she gave them about repairs!