81   He serves a three year sentence

HENRY FUCKIT'S NURSING NOTES

Part 1 | Part 2 | Part 3 | Part 4

They killed Palmer this morning. There was obviously no hope and it was convenient that he should die before lunch. A nasogastric tube was ordered. Benny Lipschitz had a lot of trouble passing it. Finally he decided it would not go down and tried to withdraw it. To his amazement it would not come out. This had never happened to him before. There was nothing for it but to use force so he wrapped the free end round his right fist, put the palm of his left hand steady against Palmer's forehead, braced a foot against a leg of the bed and yanked, like starting an outboard motor or lawn mower. It whipped out with a spatter of dark blood. Unbelievable! It had knotted itself! The patient was alive enough for his yellow eyes to register dull horror at what was being done to him. If he could have walked he would no doubt have left there and then, never again to place himself in the hands of anyone remotely medical. He vomited a quantity of 'coffee grounds' and lay groaning weakly. Anxiously Doc Lipschitz looked at his watch and moved his attack to a lower level. That did the trick. Whilst a tube was being forced up through his penis Palmer vomited with finality and gave up the battle.

Certainly I have become callous. I rarely feel compassion for them. I am tired of feeling compassionate. Now I often see them merely as sources of entertainment, hardly bothering to empathise with even the most pitiful of cases. And as a result I learn nothing.

Louw, the fat farmer, is most confused and in mortal fear for past misdemeanours. Nemesis. For stealing sheep and screwing Coloured girls he is now paying and praying.
'God sal antwoord.'

There was excitement in the ward. Approaching five in the afternoon Mr Rubinstein attempted to shuffle off this mortal coil. Action stations. Beds and lockers were moved, the doors were opened wide, the curtains were drawn round the rest of the patients and within three minutes there was the sound of running feet and the rumble of high-speed trundling. In rushed the emergency crew with Max Cart, the resuscitation machine. He was lifted on, the pneumatic arm was put in position on his chest and cardiac massage began. The auto-respirator hose was connected up and stimulants were administered IV. There were three doctors and two specialised sisters with assistance from the locals.
Meanwhile supper had arrived. Mr Patterson was in the bed alongside the scene of action and I began to feed him some soup. In his confused state he imagined he was at a garage and told me to put twenty-four pounds in the front and twenty-six at the rear. The sound of the respirator was similar to that of a compressed air pump at a filling station. Then I had to go for a cardiac monitor from the equipment room.
Because it was after five the equipment room in the basement was locked and I had to go up to matron's office for the key. Matron Schulz was on duty. She was looking for the book for me to sign when a dry squealing noise was heard from the corridor. She rushed out and shouted at the two nurses who were pushing a trolley. She came back muttering about oil, laziness and discipline, and threatening to phone the ward.
'I think they need the monitor rather urgently, Matron.'
She gave me a piercing look, checked me skew, so to speak, and handed over the keys. As it turned out there was no urgency. By the time I returned to the ward Mr Rubinstein had departed to join his maker.

I had to put Paul's tubing on Mr Patterson. He resisted and shouted, asserting that I was trying to have sexual intercourse with him. This is helping to kill him off, this violence and humiliation.

Mr Patterson went quickly but without much glory. Violated and outraged, tubing forcibly put on his cock, needles shoved in his veins, hands tied, cotsides caging him in, food and medicine poured down his throat, laughed at as a source of amusement, sworn at as a noisy troublesome nuisance. The only redeeming feature to his death was that he went down fighting.

When I had finished shaving him I was surprised to see him bring out a small hand mirror from under the bedclothes. His eyes lit with interest and pleasure at the difference. At this late stage he is still concerned with his appearance.

Mr Du Pont's wife comes every day, nearly all day, to tend him, sitting at his bedside talking quietly, soothing him, feeding him, protecting him from the callousness and brutality. Love and devotion and loyalty and friendship. She talks quietly in French. He is in constant and acute pain and distressed at his condition - body collapsing, hair falling out. At least he won't die alone. Her love might even ward off loneliness long enough to allow him to die without having to face it. But if he lingers too long…

Mr Du Pont is on a ripple mattress now that he is paralysed. He can only bear the pain if he is laid completely flat on his back. The paralysis is creeping upward. He still has some use of his hands and arms. The treatment has been discontinued and it has been decided to let him die. There is an emphasis on making him as comfortable as possible and administering analgesics whenever necessary.

Mrs Du Pont brought photographs to show how her husband looked before his illness. A smiling man of about forty with thick black hair proudly standing with his wife, children, friends. And surprisingly tall. There is little connection between the man in the photographs and this wasted creature lying in the bed, black feverish eyes trying to smile up at us in an irritating attempt to be brave.

Du Pont declared that he was about to die and called for his wife and daughter and a priest. To me he seems somewhat premature.

More often now there is a look of resentment and bitterness on Mrs Du Pont's face. She must be getting to hate this hospital and city.

A sudden commotion: Mrs Du Pont outside crying, inside Mr Du Pont shouting,
I don't want to die! I don't want to die!
Now he is sedated and calm.

Du Pont is cracking. Two days ago he summoned family and priest for he felt he was dying. Yesterday he attempted to have his last meal like a condemned man. Mince and cream cracker. Finally, after a few mouthfuls, he ritualistically swilled water in his mouth and spat it onto the remaining meat.
It is time for pressure care.
'The suffering, it is terrible, terrible. Leave me, just this time. I beseech you. Call the sister.'
'She's not here.'
'I feel she is here. Please go look.'
'No, she's not here yet.'
'No, I feel now that she is just here. Please go look. Call her. The pain, it is terrible. Please, I beseech you.'
'The sister will be here at seven, in three quarters of an hour. As soon as she comes I'll tell her.'
'No. I think she is here. Please. I beseech you. Call her. Please. I am relying on you.'
His eyes are very dark with pethidine. Pleading. Pain and fear, desperate fear. He is losing his dignity and dying ignominiously. The end draws nigh and yet I still do not detect any heavy shadow of death.

Du Pont is on the brink. Finally his head has taken on a shape to be expected. The skull looks shrunken and small and the flesh of the face itself has sunk and turned yellowish grey. The sinking of the cheeks and loss of colour seem necessary. The mouth and eyes are mad with fear. Violent hiccoughs are a symptom of an intestinal obstruction. The abdomen is distended tight and smooth as a balloon. He vomits a dark fluid that must contain a large proportion of blood. Tonight or tomorrow.

The priest has just been to see Du Pont and his wife and daughter are with him. Is it a matter of hours? Do most Catholics experience such fear? Maybe it is considered healthy to cling with such miserable tenacity.

Is anything emerging from the mist. Have I reached a conclusion?
Mr Du Pont was guarded by his wife and daughter and he died in a horrible manner. Alone, without their support and love, he would have gone sooner, without a doubt.
Is it not better to be left for the hyena, the brief bumping crunch of jaws, than to be carried and dragged for day after agonising day through the torrid tormented bush to a death that will come with the same pitiless and stinking breath, the same hot snuffle?

For a layman Hirsch knows a lot about matters medical, but he does not seem to realise the severity of his own condition. And yet somewhere far back he must surely know.
And old Mr Benton with the malignant growth in his neck, the shape and size of a young pear. He speaks with contempt of the tenebrous state of the 'quacksters' and the futility of all the tests; but he does not acknowledge the obvious - their feigned perplexity and continued investigations are perfunctory and dilatory. That fast-growing tumour will dispatch him before the month is out.

Hirsch was difficult this morning - in pain and weak. He was irritable with a foolish nurse and then later apologised to her. The fundamental decency of the man has survived right up to this late hour.

Hirsch's eyes are becoming more prominent. He shakes and gasps, from fear I think.

All and sundry, including his wife, are predicting the imminent demise of Mr Hirsch. They don't like the look of him and point out any number of tell-tale signs. His breathing is rapid and shallow. Mrs Hirsch notices his eyes, far away, staring. She saw that look in her mother's eyes.

Within two minutes Max Cart arrived without much excitement. His naked body already looks like a corpse, arms at sides, palms up. I didn't get a look at his eyes. A doctor shone a torch down the back of his throat and rammed down a tube to access the lungs. He was lifted across onto the cart, everything was connected up and the pump got going. On the fifth pump a pause. One-two, one-two, one-two, one-two, one-two - hisss. Regular as clockwork.
Mrs Hirsch had been hurried out. The son and daughter arrived and more phone calls were made.
No go. There was no response. They stopped the machinery and there was a rush of decompressed air. He was disconnected and dumped back on the bed and Max was trundled away. The face was composed, a sheet pulled up to the chin and the weeping daughter and white-faced son led in to take a last look. Where is he now? I thought. Mrs Hirsch took a brief look.
The ward was intensely still. Distant voices from the corridor. Mr Benton hawked and spat into his sputum mug, apparently unconcerned about the fate that, unbeknown to him, was zooming in.
The belongings of the deceased were put into plastic bags on a chair beside the curtained deathbed to be taken away by the relatives. A tube of toothpaste, a shaving mug, rolled up dressing gown, a slipper, bottle of cool drink seen through the transparent bag, ownerless.

I suppose they called Max for Mr Hirsch because his wife was there at the time and a show had to be put on. The orders had been that he was not for resuscitation.

'Are you a doctor? Tell me, is he a doctor?'
'No, I'm an orderly, Mr Rabkin.'
'Are you a doctor?'
'No, an orderly, Mr Rabkin, an orderly.'
'Are you a doctor?'
'No, I'm…'
'Dad, he's like an assistant to the doctor,' the son bellows in his father's ear.
'Oh.'
Shortly thereafter a doctor came to examine him.
'Look, I don't know who you are and I don't want anything of you but just that you can manoeuvre me a cup of tea.'
'Okay, Mr Rabkin.' And the doctor went off.

I wonder whether Thomas's wife has told him. She wanted time to think it over. He lies there with a magazine open on the counterpane before him and looks at me lengthily, watching for something, so maybe she has. Whether she has or not, though, he probably knows.

A nurse and I battle with the senile old man trying to get him settled in bed. He goes on about paying accounts and whether or not to speak to the man next door about getting the hedge cut.
'Get me out of here! Let me out of here! I tell you, I want to get out of here. Take this away!
We try to lift him higher and he leans back, hands behind his head and feet up on the cradle, as if relaxing at the poolside. His private nurse, Elizabeth, slumps in a chair beside the bed and gives superfluous instructions concerning the cotside, the dressing gown.
'I'm worn out.' she sighs.

'I haven't slept for months and months and months. I've asked for a sleeping tablet. I don't eat. I haven't eaten for months and months. My stomach hasn't worked properly for months. It can't.' A bald jaundiced ferret with a hairline moustache.

Berman sits stiffly upright in bed, sleeping. The reading light is poised brilliantly above him and, with his uplifted face, he looks like a saint bathed in the glory of heavenly illumination.

After the biopsy and analysis Lowry, who is fifty-four, was told that he had primary carcinoma of the liver and was not expected to survive for more than another twelve months. After being informed of this diagnosis his condition was described as close to euphoric. This was the most momentous news he had ever received and the excitement of it flushed him with exuberance. After an hour this reaction had worn off and he became morose, saying that they were through with him and had thrown him on the ash heap. There was still no evidence of fear.

Berman came back this morning for the third and final time. Panting and groaning he was strapped upright on the trolley, his face covered by an oxygen mask, a drip in his arm and a urinary catheter leading down to the bag. Ten minutes after being put in bed he was dead.
He had recognised me, seemed quite lucid behind the panic and was talking coherently enough. It was not a matter of easing into death but rather one of 'here one moment, gone the next.'
In the foyer his wife set up a wail, the doctors and sister crowding around her. She must have been expecting it for a long time, and yet this noisy public expression of grief. Should she be denied it?

The secret life of the hospital intensifies with the onset of winter. Below the surface strange things are happening in this burrow.

In the canteen I observed two doctors who, taken together, seemed to have stepped from an outrageous cartoon lampooning the personal dignity of all members of the profession.
One was well under five foot, the shoulders of his white coat hanging almost to his elbows, the bottom hem reaching his ankles. He wore an outsize mountaineer's haversack.
The companion doctor was older and remarkably tall, roughly built with strong peasant shoulders. He took off his coat, rolled it into a ball, stuffed it into an aged briefcase and threw the case under the table. He sat down with violence, wrenching the table towards him and kicking the briefcase from under his feet.
From the haversack the little man began unpacking biscuits, mugs, a gas stove, kettle and other items for a picnic. All the while they never spoke a word. Were they really doctors? Nobody else gave them a second glance.

A matron made me wait a quarter of an hour outside her office and then called me in and asked me who I was and what I was there for. I said I had been told she wanted to see me. What for? I don't know. She thought a while and then shouted at me, If you haven't finished your procedures by the end of the month you'll have to go! I was not feeling vindictive so I refrained from telling her they had been completed two weeks prior to this interview and instead smiled brightly and said I would do my very best, Matron, Sir.

The fattest man on earth. Roll up! Roll up!
When they wheeled him in I could hardly believe he was that big. Was it possible? Lifting him was out of the question so we rolled him like a barrel onto the bed, which shuddered ominously, hairline cracks appearing in the stress areas of the metal frame.
The face appeared normal, a little frightened and embarrassed, and distressed because he was short of breath. He could not lift his head even for one pillow, he was so restricted by the grossness that extended from his chest to that immense height surmounted by the everted umbilicus, nipple-like atop the taut quivering jellyfish.
Ascites, the presence of free fluid in the peritoneal cavity. Excessive drinking, 'ethanol abuse.' had severely damaged his liver, deranged his kidneys, and this was one of the consequences.
An attempt was made at paracentesis. A large hypodermic needle was inserted. I expected a fountain of water to jet forth and spray against the ceiling as from a spouting whale or a Texas gusher. Nothing happened. Vacuum pressure through a syringe produced a negligible quantity of fluid. When the needle was removed the puncture point slowly began to ooze. The procedure was repeated at half a dozen sites and colostomy bags attached to collect the effluent. The visual effect was of a giant udder studded with flaccid teats.
The patient's own explanation:
'My wife died ten years ago and the emotional shock caused this.'
An unseemly flight from reality, this transfer of personal guilt to the dearly beloved departed.

I had him to wash this morning and he was unconscious, slobbering and grunting and panting, a white froth on his lips. He died a while later and it proved difficult parcelling him up in just one shroud and sheet. When the two porters arrived with the green coffin trolley to take him off to the morgue, one of them was clearly drunk - red-nosed, smelling of cheap wine, and unsteady on his feet. He failed to hold the conveyance fast alongside the bed and we dropped the corpse on the floor, sending a seismic tremor through the east wing of the hospital. It then took ten of us to get him onto the hearse.

Rabkin left tow large pellets on the bathroom floor. It was like cleaning up at a circus.

So he went late yesterday afternoon. A blessed release and all that. I suppose it could be described as a mercifully brief period of decline. From perfect health not even six weeks.

Just after one on Sunday afternoon. It is the quietest I have known the ward. Not the emptiest but the quietest. Thomas is busy dying - how long it will take…. Today he is confused and a lot weaker.

We lifted Thomas onto the commode beside his bed. His eyes rolled and his mouth gaped, dentures loose. Ghastly yellow orbs in a taut yellow skull. Blue and yellow certainly do not go. He began to cough and I held the kidney bowl for him. Suddenly blood and bile were spurting from his nose and mouth. A quantity spattered on my arms and trousers. A doctor took a look at him and muttered to the sister to get him back into bed and clean him up. Nothing to be done. I fished out his false teeth and got him into bed and cleaned him.
His wife and daughters came and the Anglican chaplain. Later in the afternoon this parson helped me to lift Thomas, making him more comfortable. Large, strong warm hands. A man of about fifty, tall and well-built, fit looking. Blue eyes and a tanned, creased face.
'The lights. They're blurred,' Thomas whispered. 'Is it me?'

A black-robed priest came in around eleven o'clock on Sunday morning.
Good morning, everybody. I would like to let you know that we are holding a service in the chapel and you are welcome to join us. If you can't come I would like you to know that we will be thinking of you and praying for you.
There were murmured thank you's and then a calmness and silence after he had gone. It had been the deep clear voice of a disciple.

I have been transferred to C2, the orthopaedic ward. Instead of two large general wards, male and female, there are several small rooms with from one to four beds in each.
I must adjust to the slower pace and routine that is different in some of its details. To make the time pass I must try to keep busy. Each task can be done more slowly and thoroughly and more time can be spent talking to the patients. Once it is seen that I work efficiently and reliably I shall be able to lengthen the lunch hour and take extended tea breaks.

An angry orderly, tall, thin and wiry - a Woodstock White with thick black hair and a dago moustache:
'My mate, come and help me before I choke that fuckin' lot in there. God help me if I don't fuckin' choke that bitch. She's supposed to be a nurse. Can't she help a man? Christ. I've got no time for the woman. As true's God I'll choke her.'

A hot clear day, a beautiful morning to be outside. The sea must be calm and exuding freshness. Singer is playing a tape of lifting Soul. He lies there puffing on a cigar and blue wisps of aroma drift with the music through the ward. There is an atmosphere of sleepy quiet.

Randall is emaciated with a terribly distorted rib cage. He has a single yellow fang and a productive cough.
'Is it difficult being old?'
He does not hear. A gloomy prospect, this old age business.

Davis is full of complaints and dithering nonsense but he has a dry sense of humour. Three bottles of milk stand on the window sill maturing in the sun. This is his 'curds and whey.' In his locker he has a bottle of whisky and he would tipple through day and night if not discouraged.
'And they try to tell you about religion and that we were put here by God. How ridiculous!'

Old Mr Davis is eighty-two. Until he was seventy-six he swam the year round in the cold Atlantic off Sea Point and walked the mountains from Signal Hill to Cape Point. Then, whilst painting his house, he fell from a ladder and broke a leg. The fracture healed but he developed a respiratory complaint which he calls 'emphysema.' Now he has broken a hip.

From too much love of living,
From hope and fear set free,
We thank with brief thanksgiving
Whatever Gods may be
That no life lives forever;
That dead men rise up never;
That even the weariest river
Winds somewhere safe to sea.

Then star nor sun shall waken,
Nor any change of light:
Nor sound of waters shaken,
Nor any sound or sight:
Nor wintry leaves nor vernal,
Nor days nor things diurnal;
Only the sleep eternal
In an eternal night.

The appreciation of poetry, vigorous exercise in the outdoors, a staple diet of sour milk, moderate but regular intake of malt whisky and a vehement refusal to do anything blindfolded or against one's better judgement: these are the keys to longevity.
He is half-cut on his whisky and fiercely serene, lying there reciting from memory verse upon verse, eyes glinting with an obdurate light, voice shaking with emotion.
'Why are these damned Christians so afraid of death? Why can't they see that Swinburne was right? 'Only the sleep eternal in an eternal night.' What is there to fear in that?