Against the Tide

by Noël Browne

  As a student I was presented with the need to make a judgement on the issue of euthanasia. Possibly many will accept as wisest and most humane the attitude adopted by the physician with whom I was caring for a newly-admitted case, which was that the decision should be left to the discretion of the experienced medical attendant. Our patient was a young motor mechanic, who had been working on a car. He needed petrol and, thoughtless about its dangers, had struck a match to light a cigarette. The petrol can exploded all over him and he was drenched with flaming liquid. All that remained of the skin of his body was a nearly invisible narrow red slit, the remains of his lip, covering the inner edges of his mouth. His whole body was now an excruciatingly painful, jet black, smouldering, quivering cinder.

  I was astonished to see that in spite of the appalling damage to his body those residual lips still moved in low moans of pain. Clearly there was no hope for the man’s recovery. Nothing could be done for him by us. I believe that the physician was right in deciding to inject a massive overdose of morphia into the man’s body. At the time I was shocked by the awesome finality of that Godlike act. There is little doubt that, in time, society as a whole will come to accept the need to share with the profession such grave responsibilities which many now accept in lonely isolation on society’s behalf.

  While I was at Dr Steevens’ Hospital a strange fatal accident case was admitted about which I am still puzzled. This man had survived the 1914-18 war, and had volunteered as a rifle shooting instructor. It was the practice for the instructor to lie flat on the ground, faced by his pupil, also lying flat on the ground, just a few inches away. The pupil held his .303 rifle to his shoulder in the conventional way and took aim. The hairline front sight had to be at the bottom of the rear ‘V’ sight. The instructor held a four-inch fine wire circle in the centre of which there were two dead straight wires of equal length, crossed as in a crucifix.

  It was the instructor’s function to educate the pupil to fix the front hairline sight in the bottom of the rear ‘V’ sight of his rifle, then to fix these two at the exact point at which the two wires crossed at the centre of the wire circle. The instructor then had to verify the correct position of all of these components of the exercise.

  On this occasion, during a nightime instruction, the instructor, with one open eye, judged all this to be correct. He advised the pupil to make his first gentle pressure, then the second longer pressure on the trigger, so as to fire the rifle. Then he shouted his command, ‘Fire!’ The instructor was dead, shot through the brain. We recovered the bullet from the pelvis. All my life since I have wondered about that death. It was an incredibly unlikely accident. Was it murder? Was it a thoughtful suicide? The coroner’s verdict was the usual anodyne and meaningless one, ‘death by misadventure’.

  While in Steevens’ Hospital, I became involved in my first struggle against what I believed to be an injustice by authority. The matron of the hospital was a Miss Reeves, a fine lady, with strict Victorian attitudes to individual behaviour. She was a first-class matron and had built up a training school with such standards of skill that the nursing in the hospital was quite superb.

  Miss Reeves believed that only by exercising a nearly penitential pattern of discipline could she achieve and maintain those high standards with the raw young girls who came from all parts of Ireland for training. The Nurses’ Home was run like a Carmelite monastery. Absolutely no fraternisation was permitted between the young girls and the medical students on the staff, or indeed, any male companion. Diet was spartan, the last meal possibly sardines on toast at five o’clock in the afternoon.

  It was the practice then to treat consumptives suffering from tuberculosis of all forms with many strange, painful, even at times lethal procedures. The truth was that we did not know the cure for the disease. One of the principles of treatment was the belief that fresh pure air, ideally like that of Switzerland, would help to kill the germs, but there was no scientific proof that this was so. The Swiss hoteliers were delighted with their continuously filled rooms. Yet a desperate disease merited desperate remedies and the patients were encouraged to sleep out of doors on open verandas. Sanatoria were invariably built with such verandas in the heart of the country, and the unfortunate patient, winter and summer, slept in the open air, depending on the whim of his doctor or his particular nostrum for this frightening disease.

  The nurses were compelled to work through the night in short-sleeved uniforms, and became more and more perished with cold as the night wore on. I shared their belief that this was unreasonable and that a sweater, cardigan or pullover should be permitted. At that time, the overall leadership of the nursing profession was particularly obsequious and deferential to the members of the medical profession, especially to the consultants. They successfully promoted the idea that nurses belonged to an angelic sector of society who must dedicate themselves entirely to the sick, as though they had a religious vocation. Nurses were led to believe that membership of a trade union or preoccupation with terms of employment and living conditions in hospital was improper and certainly not to be considered as subject for public protest. They accepted with awesome docility the discrepancies between the doctors’ income and their own in their separate vocations.

  I agreed to approach the matron on their behalf to win more reasonable treatment for their grievances. It was agreed that I would act as spokesman for the group and that they too would come with me to the matron’s office. We assembled in the TB ward at the top of the hospital, about twelve to fifteen nurses to start with, and I led the way down the long winding stairs. There were desertions on every floor. The sad end to the story is that by the time I arrived at the matron’s office and pressed the bell on her door, not a single nurse was left with me. Lamely I made the case, which was listened to with obvious impatience by the matron. Nothing was done to change the harsh conditions of the nurses. It was Miss Reeves who ‘tut-tutted’ and sent back to work a gentle vivacious young nurse, who complained to me of not feeling well and of having headaches. Clandestinely, I had an X-ray taken of the girl. To our dismay, and I choose the word deliberately, the picture showed the dreaded ‘snowstorm’ effect of galloping consumption or miliary tuberculosis. The unfortunate girl had between six weeks and three months to live. Her death was a truly terrible one, slow and intensely painful. She went totally blind before the end.

  In urban areas such as Dublin in the 1930s and 1940s, the two most consistent killers of infants were gastro-enteritis and diphtheria. The gastro-enteritis was largely due to the fact that the milk supply was dirty: the effect of poor hygiene on the farm and in the home of the consumer. With low educational standards, a lack of proper water supply and inadequate sanitary conditions and domestic facilities, bad hygienic conditions were inevitable. Any of these factors could contribute to the spread of this lethal condition through the infant population of the community, and many babies died needlessly.

  I recall my sense of total helplessness when I was ‘on the district’ as a Rotunda medical student. With another student, as inexperienced as I was, I had been called out to what turned out to be a perfectly normal birth. A fine, well-formed infant lay on the bed, delivered nearly spontaneously by the mother. Yet the child did not breathe freely and suddenly ceased to breathe altogether, rapidly losing consciousness. He died before our eyes. The mother was distraught at her loss, and we knew in some way we had been at fault. The incident was what is known as the ‘white baby’ syndrome, and the remedy is simple to the initiated. There is an instrument, nearly as old as the practice of midwifery, which, if used promptly, can extract the plug of mucus that could have saved that child’s life for its mother. Death was the result of my inadequacy. That child should not have died. Yet surely those who devised a system where inexperienced students could be sent out in a state of ignorance were also to blame? Though I persuaded myself of this, it was of little comfort to me.

  On another occasion I was called out ‘on the district’ to a back street near Belvedere C
ollege, to a loft over a stable. In order to get to the loft where the lady was about to have her baby, I found it necessary to climb a nearly vertical ladder. Light was provided by an oil lamp. A large black iron brass-bound bed, complete with feather mattress, stood in the centre of an otherwise empty room. There was no running water. While the unfortunate woman lay in labour, a hen sat perched asleep on the top rung at the foot of the bed. How did that pregnant woman get to that loft? What was to be the fate of that child, brought up in those conditions? The woman at one stage was compelled to leave her bed and, like a horse at a fair, void her urine on the floor. Could a woman have been more humiliated? She then returned to her bed and, with little help from me, went on to have her baby.

  In the last summer before the Second World War broke out, I sailed to the west coast of France in an old luxurious gaff- rigged yawl, the Samphire, once owned by Lord Lloyd. My companions were Bill Chance, Robert Stoney, William Pike and Major Bob Clements. Bill Pike, a second-row rugby forward stood on the narrow edge of the yacht’s dinghy, which was laden to the gunwales with stores, and, in an attempt to climb aboard the Samphire, upended everything into Dun Laoghaire harbour. This was an inauspicious start to a voyage which for me would prove disastrous.

  Within hours the engine stopped and refused to work thereafter, in spite of being vigorously coaxed into action with red-hot plugs, fried in the pan by Bill Chance. Later, shortly after midnight, dozing uneasily in heaving, soaking-wet bunks, we were all routed out by the ominous cry, ‘All hands on deck!’ We were in the heart of a storm and the mainsail halyards had been carried away. I stumbled on deck in my pyjama trousers into the wind and rain, to see the intermittent light on the stark black Tuskar Rock. Later, near Brest, when it seemed we would have to abandon the yacht with only four life-jackets, it fell to my lot as the youngest unmarried crew-member to swim for my life to the shore, which seemed about a mile away. Happily, the emergency passed.

  Our troubles were not yet over. As we cruised in the inland waters around Concarneau, I noticed a bubbling straight line in the water, coming directly towards us. It was through below and away astern before we realised what it was; we had been torpedoed. Foolishly, we had strayed on to a French naval torpedo range, and a peculiarly humourless matelot had decided to practice his lethal skills on us. The torpedo head was a dummy, but even a dummy torpedo at the wrong depth could easily have sunk our old timber yawl.

  We finally left the yacht at Southampton in September 1939, just as Britain’s young men, humping their duffle-bags, mobilised for war. (The yacht, I understand, was later destroyed by German bombing.) We had had nearly continuous rain, with never-ending gales. In nearly all the photographs of the journey I can be seen with my head down on my arms, sleeping; because I suffer from seasickness, I found it difficult to sleep below.

  However, when I returned to Dublin the sleepiness and continual weariness, no matter how much I rested, together with the loss of weight, compelled me to look for medical advice. A chest X-ray confirmed that I had quite serious tuberculosis on both lungs which would require immediate hospital care.

  Suddenly the possibility of years in bed lay ahead. In spite of my experience of the disease I did not appreciate that there was no certain cure for tuberculosis and that death was relatively common. I was more concerned at the abrupt end to my pleasant student life, my lectures, clinics, sporting and social activities. In addition, there was one other disappointment to be faced; I had already passed two parts of my three final examinations, but if a Trinity student did not complete the three examinations within eighteen months, he had to forfeit the examinations he had passed and start all over again.

  This was one of the very few occasions on which I missed my own family. I wanted them to share and, no doubt, comfort me in my misery. The Chance family, as always, were uncritically kind, concerned only to console me, but the two doctors among them had some idea of the testing prospect of months in bed for a young man of whose family so many had already died of the disease.

  It is difficult now to comprehend the sense of shocked disbelief with which one heard of a friend’s misfortune in contracting tuberculosis. People faced not only personal isolation but also nearly inevitable residual physical disability or even death. Possibly the most chilling experience occurred when I was kindly taken into the Chance home, to await hospital accommodation. Some time later I learned that the woman who acted as domestic help declined to come near the room in which I lay to assist me or bring me my food. She was simply frightened of contracting the disease. Overnight I had joined the ghetto of the tuberculosis lepers in Irish life.

  This is not an unfair description of the public attitude to tuberculosis; sanatoria were built when possible in the country, some distance from the urban areas. It was the common practice to send off the servants of the ‘big houses’ immediately they contracted the disease, the further away the better. A nearly hysterical fear of tuberculosis was universal. It affected all classes, because there was no certain cure, and as death took a long time and could be painful, this fear was understandable. A bus conductor once told me that many passengers, in fear of their lives from tuberculosis, would hold their breath when passing Newcastle Sanatorium in case they caught the germ.

  Yet the terror of tuberculosis was not confined to the ‘illiterate peasant’. I remember being called to a very sick woman in a sanatorium where I worked. She had undergone a new and experimental operation on the previous day which had, unfortunately, gone badly wrong. Her lung had been perforated. As a result of the strange structure of the lung coverings, she continued to exhale air with each breath into her surrounding tissues. Her whole chest was grotesquely distended with air, and crackled like tissue paper to the touch. Nothing could be done for her. Pitiably, she gasped out that simplest of all wishes, ‘If I could only breathe’. Since she could not live, I had called for the Catholic curate, so that she might have the last comforts of her religion.

  The priest, a fine robust man, a brave rider to hounds and bon viveur, strode into the ward in which lay my dying patient. He was unrecognisable until he spoke, and even then was almost unintelligible. He could not see too well. All that was to be seen of his face were his two bright black eyes. To my amazement, he wore an enormous snow-white surgical gown, strapped around his great circular frame. On his head was an operating theatre skullcap; on his face the nearly totally concealing surgical mask. The ward could have been a surrealist set for a dream sequence by an avant garde Scandinavian film producer. This was one soul to be saved that was not worth the priestly risk of contracting tuberculosis. Here was one ‘brave’ man who did not intend to risk his health to help this dying woman ‘make her peace with God’.

  The disease could show itself by a cough, followed by the appearance of blood in the mouth, then the dramatic scarlet on the white handkerchief which I had first noticed in the case of the Christian Brother in Ballinrobe. It was a peculiarity of the disease, never explained, that if it first showed itself by the coughing of fresh red blood from the lungs, then every succeeding recurrence, if the patient survived the first attack, showed itself with bleeding from the lungs. The real importance of this distinction was that onset by haemorrhage usually meant that the unfortunate patient would finally die in conditions of uncontrolled bleeding. Since the outpouring of blood from the ruptured vessel could not be removed fast enough from the lungs, the victim drowned in his own blood.

  After some consoling visits, I now had to face the loss of my friends, and my happy life with them. I had just come to know Phyllis Harrison, who was to become my wife; we had met at a Trinity Boat Club dance by the Liffey. Common sense dictated that for her own protection she should forget our friendship; remarkably and happily for me, this she did not do.

  I was an exception to the general rule that while the wealthy were treated under ideal conditions, so long as they could pay, the rest of the population were compelled to wait at least one year before being admitted to a badly-equipped, slum standard
sanatorium where the staff could do little or nothing for the unlucky patient. It was my good fortune to have the support of the Chance family, without whom I would not have been able to pay for treatment. When it was accepted that there was no effective treatment for me in Dublin, I was sent to the King Edward VII Sanatorium in Midhurst, Sussex, in the summer of 1940.

  I had one natural asset, evident on the night on which my father died and again when I was so full of fear on the lorry near Ballinrobe: I could always sleep. On wonderful summer nights in Midhurst, in my moon-filled room, I would weep in angry self-pity, but then I slept, blessed relief. My second asset, which I developed with time and practice, was reading. In all my waking hours I can safely say that I rarely took my eyes off the printed page. I read through the hospital libraries, and then more.

  I also bought a tiny radio, costing £4, and so enjoyed the pleasure of listening to talks, debates, theatre, discussions on virtually everything. My new life in bed became peopled with new friends, ideas, new perspectives on human relationships and society hitherto untouched in my mind, and I began to question the many easily-assimilated verities of my old world as part of a more serious attitude to a life purpose. This was probably greatly helped by the eclectic nature of my reading. This constant reading and listening, with all the time in the world to dwell on what I had newly come to know, emphasised for me the barren muscle-bound shoddiness of a formal English or Irish education. A young Guards officer, Mike Bolitho, later killed in North Africa, introduced me to the great pleasures of classical music. The walls of my prison had ceased to some extent to press in and suffocate me.