In the Midst of Life

by Jennifer Worth

  Colostomy: when the bowel is surgically attached to the skin so that faeces are excreted into a bag which can then be emptied.

  Congestive heart failure: heart failure is when the heart, which is a large muscle, begins to enlarge and get weaker through age or disease. This means it has to work harder to maintain normal heart function. The disease can be controlled at times by certain drugs.

  Coronary arteries: the arteries of the heart. There are four arteries which supply the heart muscle with oxygen. Coronary failure: another term for heart failure. CPR: short for cardio-pulmonary resuscitation: the full term for resuscitation.

  Craniotomy: removal of part of the skull bone during a surgical procedure to the brain.

  Cross-matching: this is a process which is carried out to make sure the person is given the right type of blood during a blood transfusion.

  Cyanosis: lack of oxygen in the body’s tissues leading to a blue colour in extremities.

  Defensive medicine: medicine and treatment carried out to prevent complaints and safeguard against malpractice.

  Defibrillator: a machine which delivers electric shocks to the heart, to try and reverse fibrillation of the heart muscle.

  Dementia: a disease which causes the brain to begin to degenerate. There are over two hundred different types of dementia, the most common being Alzheimer’s. The disease is not curable.

  Dialyse: pertaining to kidney dialysis, a process where the blood is mechanically filtered because the kidneys are unable to perform this function.

  Diuretics: drugs which increase the drainage of urine out of the kidneys, often used to reduce blood volume, e.g. in high blood pressure and heart failure.

  Draining filaments: a drain where the end is frayed out into filaments: used to drain wounds or wound cavities.

  Duodenal ulcer: an area of the duodenum, which becomes very sore and excoriated. This can cause pain, indigestion and nausea.

  Duodenum: first part of the small bowel leading away from the stomach.

  Electrolyte balance: electrolytes are substances produced by the body which maintain healthy functioning. Certain electrolytes include potassium and sodium. If the levels become abnormal such as in kidney dysfunction many of the body’s otherwise normal functions may go wrong.

  Embolism / embolus / emboli: an object migrating from one part of the body to another which occludes a blood vessel, e.g. blood clot.

  Encapsulated: a growth confined to a specific, localised area.

  Endogenous clinical depression: depression that people are born with. It is thought it may be genetic.

  Endomorphs: endorphins, the body’s natural morphine-like substances which give the ‘feel good’ factor.

  Endotracheal tube: a tube placed into the lungs via the mouth and throat. It may be used during surgery to help a person breathe. It is usually temporary.

  Epiglottis: a cartilaginous flap of skin which lies between the trachea and the gullet. When swallowing food, saliva or fluid, the epiglottis closes over the trachea to prevent food going in to the lungs.

  Erythrocyte sedimentation rates: the rate at which red blood cells precipitate within an hour. ESR is a general test indicating the presence of inflammation within the body.

  Excoriated: when skin becomes raw, sore, and the top layers are removed.

  Exudate: a fluid that filters from the circulatory system into lesions or areas of inflammation.

  Feed-pegs: or peg tubes: tubes inserted directly into the stomach through the skin which can allow liquid feed to be given to the patient. Useful when patients lose the ability to swallow such as after a stroke.

  Fehlings solution: used to detect sugar in the urine.

  Fibrillating: when the heart muscle is rapidly twitching in an uncoordinated way.

  Flavine gauze: gauze soaked in flavine, an antiseptic.

  Gastrectomy or gastric resection: this is when part or the whole of the stomach is removed.

  Gastric intubation and suction: A tube inserted through the person’s nose into their stomach (called a naso-gastric tube) which can then be used to drain the fluids away more comfortably and cleanly. A syringe can be attached to the tube and used to remove the stomach’s contents by ‘suction’.

  Gastro-enterologist: a specialist in the gastro-intestinal tract, digestion and its disorders.

  Glucose and saline infusion: (see ‘infusion’ as well) an infusion into the vein of a mix of weak saline (salt) and glucose (sugar) solution.

  Glyceryl trinitrate: a drug used to treat angina.

  Glycosuria: the excretion of glucose into the urine.

  Haemoglobin levels: haemoglobin is a protein in red blood cells which carries oxygen.

  Hallucinogenic: substances causing hallucinations.

  Hardened arteries: arteries are normally elastic to cope with the pressure of blood being pushed around the body: this elasticity allows the arteries to maintain the blood pressure.

  Hemiplegic: one-sided weakness of the body.

  Hiatus hernia: caused by the upper part of the stomach pushing through the hole in the diaphragm.

  Hippocratic Oath: historically, an oath taken by doctors to practise ethically in medicine. It has been taken over by another oath in the USA. In the UK it has been taken over by a different code of conduct.

  Huntingdon’s chorea: a degenerative disease of the brain, whereby the person suffers physical, cognitive and functional effects. It is hereditary and always fatal.

  Hydraulic air bed: a specialised bed used to prevent pressure and bedsores in someone with reduced mobility.

  Hypoglycaemia: low blood sugar levels. Can occur in diabetics when they do not take in enough glucose from their diet.

  Hyper-glycaemia is high blood sugar levels, again caused by diabetes. Symptoms build up over several days but if not treated it can affect vision, nerves and circulation.

  Hypothalamus: a very small part of the brain, which controls temperature, hunger, thirst and circadian rhythms (the twenty-four-hour body clock).

  Iliac crest: part of the pelvic bone.

  Iliac vein: main veins of the pelvis.

  Infarction: the process of tissue death caused by lack of circulation to the area.

  Involuntary reflexes: these are the body’s responses to certain things and which cannot be controlled by the mind.

  Irritable bowel: a disease in which the bowel becomes irritated by something, either an allergy, disease or drugs, which causes profuse diarrhoea or constipation.

  Ischaemic heart disease: death of heart tissue caused by blockage of blood vessels.

  IV’s: short for intravenous, a term used for anything given via a vein.

  Jugular: the largest vein in the body, situated in the neck.

  Ketones: a by-product of the breakdown of fatty tissue in the body, usually occurring in diabetics.

  Lapatoromy: This is the name of the surgical incision to the abdomen.

  Laying out: often called ‘Last Offices’. This is the process of preparing the body of someone who has just died for burial.

  Leukaemia: Cancer of the bone marrow.

  Lasting Power of Attorney (LPA) - Health and Welfare: the only legally recognised way a person can make a medical decision on behalf of another. This power only comes into effect when the person loses capacity i.e. the ability to make a decision. It must be registered (proven by a hologram sticker on the document, and an official rubber stamp) and must be seen by the medics and people treating that person at the time. The person acting as the attorney can only make decisions within the remit of what they think the person they are representing would have wanted in that situation.

  Lumbar puncture: an investigative procedure in which cerebrospinal fluid is removed for analysis.

  Mastectomy: removal of all or part of the breast.

  Mersalyl: an early diuretic which contained mercury.

  Metastasis: a single site where the cancer has spread, a single secondary. Metastases is the plural and means multiple secondaries.
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br />   MRSA: Methicillin-Resistant Staphylococcus Aureus: a highly contagious and resistant bacterial infection requiring strong skin cleansers, and antibiotics.

  Multiple sclerosis: when the myelin sheath (insulation) around certain nerves is affected which slows down the passage of nerve messages. There are several types of MS, some more progressive and damaging than others.

  Nasojejunostomy tube: tube that is inserted through the nasal passage, into the gullet, through the stomach and into the small bowel, the jejunum.

  Necrotic: dead and decaying: e.g. necrotic skin is blackened skin caused by lack of circulation.

  Neurodegenerative disease: disease which causes deterioration of the nervous systems.

  Neurologist: a specialist of the nerves, the nervous system and related disorders.

  Oedema: swelling of the tissues of the body caused by poor circulation.

  Oestrogen / Progesterone: these are female steroids, better known as female sex hormones.

  Oncologist: a doctor specialising in treating cancer.

  Oncotic pressures: when blood is more concentrated and attracts water into the circulatory system.

  Open heart resuscitation (direct manual compression): heart compressions applied directly to the heart through an incision made through the skin, sternum and membranes.

  Palliative care: care of patients with incurable disease and their families. In chronic disease it will begin when the disease can no longer be assisted by drug therapy.

  Paraldehyde: a substance originally used to control convulsions, and as a sedative and hypnotic.

  Paralytic ileus: when the small bowel paralyses itself.

  Paramedics: specially trained professionals who attend emergencies in the community.

  Parenteral: given via external route instead of via the gastrointestinal route.

  Path lab analysis (short for pathology laboratory analysis): analysis of certain body tissues or fluids.

  Pathologist: a specialist of pathology.

  Pelvic colon: the colon is the large bowel.

  Peripheral: on the edges of the body.

  Peritoneal cavity: the abdominal cavity, which is surrounded by the peritoneal membrane.

  Peritonitis: inflammation of the peritoneum, the membrane lining the abdominal cavity. It can be caused by infection, disease or injury. It needs to be treated with strong antibiotics or an operation, and can be fatal.

  Placebo: a substance with no active element or drug, often used in trials against a real drug to see whether the latter is more effective.

  Plaques: in Alzheimer’s dementia, small clumps of proteins that grow around brain cells and prevent normal functioning.

  Pleural aspiration: drainage of fluid, which has built up between the pleural membranes surrounding the lungs.

  Pneumococcal organisms: the bacterial cause of pneumonia.

  There is now a vaccination to protect people from this.

  Polyuria: excessive production and excretion of urine.

  Positive pressure: when the pressure within a system is higher than that of the environment it is in.

  Potassium citrate: a substance used to dilute acidic urine.

  Primary progressive aphasia: when words are muddled and mixed up, and speech is then lost altogether.

  Prostatectomy: surgical removal of the prostate gland.

  Psycho-geriatric ward: now called Elderly Mentally Ill (EMI) wards. This is a ward specially designed to care for elderly people who have mental health problems.

  Psychosomatic paralysis: paralysis caused by the unconscious mind.

  Pulmonary oedema: fluid congestion in the lungs which may be caused by heart conditions.

  Radiotherapy: treatment of cancer using radium.

  Remedial therapy: treatment to aid recovery: it tends to be non-pharmacological in nature.

  Respiratory drive: this is controlled by a part of the brain which measures how much carbon dioxide is present in the blood and controls how the person breathes.

  Retractor: a surgical instrument which is used to hold back skin, muscle or bone to allow better access and vision during surgery.

  Rheumatism: a condition of the joints and connective tissue.

  Rigor mortis: after a certain period following death, the muscles of the body begin to stiffen.

  Sarcoma: a cancer of connective tissue, i.e. bone, cartilage or muscle.

  Sclera: the white part of the eyeball, which is made up of elastic fibrous tissue.

  Septicaemia: infection in the blood.

  Serum: the watery part of blood, which carries the red and white blood cells, and platelets.

  Shock: bodily collapse or near collapse caused by inadequate delivery of oxygen to the cells from decreased heart functioning, e.g. from excessive loss of blood.

  Sigmoid colon: this links the anus and rectum to the large bowel.

  Sloughing: when part of the body becomes detached, usually linked with wounds and skin in humans.

  Staphylococcal infection: a particular type of bacterial infection caused by the Staphylococcus bacterium.

  Statins: a group of drugs used to reduce the blood cholesterol level.

  Sternum: the bone that connects both sides of the rib cage at the front.

  Stertorous: heavy mouth breathing, characterised by loud snoring or gasping noises.

  Suppuration: the formation and production of pus.

  Supra-pubic catheter: a tube placed directly into the bladder through the skin, just above the pubic bone.

  Surgical shock: similar to normal shock, but caused by surgery.

  Thrombosis: a blood clot occurring in a blood vessel.

  Tibia and fibula: the two bones of the lower leg, between knee and ankle.

  Titrated / titration: when a drug or treatment is given according to how much is needed by the patient before too many side effects, or intolerance, develops.

  Total parenteral nutrition: complete nutritional diet given intravenously. It is mixed in sterile conditions according to the individual’s daily blood tests and contains all the calories, nutrients, vitamins and minerals a person needs.

  Tracheostomy: a hole made in the throat wall into which a tube is placed into the bronchus, the main breathing tube into the lungs. A tracheostomy tube is placed in this man-made hole to keep it patent, e.g. a Durham’s tube.

  Transient ischaemic attack (TIA): a small stroke with little or no long-term effects on the person. But a doctor should be seen urgently if one occurs because without treatment a major stroke could follow.

  Trephining / trephine: when a burr hole is made through the skull, using a drill, as part of a surgical procedure.

  Trocar and cannula: a cannula is a thin ‘needle’ structure often made of plastic which can be inserted into the body. The trocar is the introducer, a thin piece of stable metal, which assists its placement. The trocar is then removed.

  Uraemia: high levels of urea on the blood.

  Urethra: the tube that transports urine from the bladder during excretion.

  Urinalysis: a simple test of the urine to look for any problems.

  Urine drainage bag: used to collect urine drainage via a catheter.

  Vascular dementia: dementia caused by lack of circulation of blood to various parts of the brain causing the death of those affected parts and therefore affecting mental functions.

  Ventricle: the larger chambers of the heart.

  Ventricular fibrillation: fibrillation of the ventricles, the two largest chambers of the heart.

  Voluntary euthanasia: when someone’s life is actively ended with their agreement, and with the help of someone else using specific drugs.

  Volvulus: a blockage of the bowel caused by it twisting in on itself.

  Warfarin: a blood clot-dissolving drug which tends to be used prophylactically to prevent further blood clots forming.

  White cell counts: white cells exist in the blood and fight infection. If a person is not producing enough white blood cells they will be immunocompromised.
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  ACKNOWLEDGEMENTS

  My appreciation and gratitude to all the people who have helped me in writing this book.

  My husband, Philip, whose love and loyalty, wisdom and humour have kept me sane throughout

  Dr David Hackett, Dr Richard Lamerton, Dr Michael Boyes

  Dr Robin Moffat, President of the Medico-Legal Society Susan McGann, Paul Vaughan and Susan Watt of the Royal College of Nursing

  Louise Massen and Madeline Bass

  Patricia Schooling, for her several readings and invaluable suggestions All those who have supported me in prayer, especially Sister Christine and the Community of St John the Divine, Birmingham; Sister Elizabeth and the Convent of Our Lady, Kettering; the Sisters of the Love of God, Oxford

  The Chaplains of the Methodist Homes for the Aged, and St Francis Hospice for the Dying

  Colin Rivett, Eve Griffin, Jeremy Buckman, Counsellors

  Anna Powiecki, Eugenie Furniss and Claudia Webb at William Morris, Endeavour Entertainment, John Saunders, Kirsty Dunseath, Sophie Buchan and the team at Weidenfeld & Nicolson, Carole Lewis, Sue Theobald, Christoper Howe

  David Hart, poet, priest and dreamer

  Patricia Birch, Joanna Bruce, MBE; Sue, Jayne and Jane, my sister and nieces who are nurses and care assistants

  Lydia Hart, Eleanor Hart

  Shelagh and her family in Israel, and Steve and Sandy, Wendy and Philip.

  — and the many people who have told me their stories but do not wish to be named.

  Excerpt from Nurse on Call by Edith Cotterill, published by Ebury, Reproduced with permission of The Random House Group Ltd.

  Excerpt from How We Die by Sherwin B Nuland, published by Chatto & Windus. Reproduced with permission of Random House Group Ltd.

  Excerpt from ‘Do not go gentle into that good night’ by Dylan Thomas from Poems, published by JM Dent, a division of the Orion Publishing Group. Reproduced with permission from David Higham Associates.

  Excerpt from Four Quartets by T.S. Eliot reproduced with permission of Faber.

  Excerpt from Malone Dies by Samuel Beckett reproduced with permission of Faber.

  Poems by David Hart reproduced with permission of the author and Five Seasons Press.

  All efforts have been made to obtain permission for the use of the excerpt from Truman of St Helens by Shirley Rosen. Anyone with rights to this book is invited to contact the author.