DRAMA ON C5

Not long ago I found myself in the hospital with suspected appendicitis, but this story is not about me.

It wasn’t long after the evening change of shift that the drama started, and it centred around the lady across from me, Emily. She was on oxygen and was groaning all the time from pain. The nurse came and told her she had to put down a nasogastric tube to suck out the contents of her stomach, relieve the pressure and make her more comfortable. She was not happy about the procedure, but the cheerful, very efficient nurse managed it with a minimum of fuss.

I still had seen no doctor, but every so often someone would report that she was still on her way. It was now about quarter to 11, and Emily suddenly started making a fuss, wanting her "usual tablet." But she of course had this tube down her nose into her stomach - and an IV was running, there was no way they were going to give her the usual night time tablet. She became more and more agitated - and as it turned out the tablet was “for her fits” and she was very worried about what would happen if she didn’t have one. And before long, the doctor herself finally arrived. She said hello to me, but said she would deal with Emily first.

The doctor was young, and she had long, rather dank, auburn straight hair. She was wearing a black short sleeved front-buttoning sweater and tight beige stretch pants and black boots. She took some blood from Emily’s arm, and then tried to explain to her why she couldn’t have an oral medication. Emily said, “But the consultant said I had to take the tablets every night and if I don’t I will have a fit and I will die.”

Doctor said, “Lots of people have fits and they don’t die. You won’t have a fit, Emily, and you won’t die.” But Emily persisted and was becoming quite hysterical about it. The doctor, who had been sitting beside her holding her hand now said very loudly and firmly, “Look at me Emily. I am the Doctor. I am telling you, you will not have a fit. You are very ill, and if you do have a fit it will be from that, not from not having your tablet. And there is no way I can give you a tablet now.”

Now the poor tired doctor turned her attention to me. She took a history of this episode, then she prodded my abdomen starting gently and then more firmly, watching the strength of my reaction to her probing. Then she dug deeply into my abdomen and very quickly drew her hand out and the pain was enormous. “That,” she said, “is called the rebound test, and the question is whether it hurt more when I probed you, or when I withdrew my hand suddenly.” No doubt about the answer to that question. “Well,” she said, “You are a real puzzle. You are not at all typical of anything. I will order some x-rays to see if there are any holes or unusual bulges.”

About 2 a.m. a porter took me in a wheelchair down to the x-ray department.which took about half an hour but I got no sleep at all that night.

About 7 the next morning our medical team came on rounds and went first to Emily.Although we couldn’t see, we could all hear and imagine everything that was happening within. The girl doctor from the night before was part of the team - looking even more exhausted. But the first one to speak was a male doctor. He said to Emily, “I’m afraid we have some bad news for you. We have had the results of your x-rays and the tests of the contents of your stomach and blood tests, and you are going to need to have an operation, and if you don’t you won’t be getting better.”

“I don’t want to have an operation.”

“It is your choice completely, but I must make clear to you that we found that you have a hole in your intestine, and that if it is not operated on and we do a colostomy, you will not get better.”

“I don’t want a colostomy.”

“I’m sorry this sounds very brutal, but if you don’t have an operation you will die. If you do have it, there is every chance that you will be able to go back to your normal life, and when you are better, we can reverse the colostomy. But it is your choice. We can’t force you to have an operation if you don’t have one, but if you don’t have one, you will die. I’ll give you five minutes to think about it,” and then he went out of the ward.

Then the girl doctor spoke to her, “Emily, only you can make this decision. Not the doctor, not your family, not me. It is for you to decide. But a colostomy is not such a bad thing. The Queen Mother had one. I’ll bet you didn’t know that and look how well she coped. I know when you came in here two weeks ago, it was to do with your asthma, and then we found out that you have this hole in your intestine and that is a very serious thing and needs immediate treatment. I will call your daughters to come and talk to you about it, but remember it is your choice.”

Emily said, sobbing now, “I don’t want a colostomy.”

"Well, I’ll come to see you again later. They will get the surgery all ready for you in case you change your mind because if it is going to be done, it has to be done as soon as possible.”

It wasn’t long before the two daughters came in. One was about 30 and was plumpish and quite quiet. The other was younger with a small baby. The girls had no hesitation at all in trying to influence their mother’s decision. From the moment they arrived they said over and over. “You have always been so strong, and had such courage. You can do this. You were so scared it was cancer, and it isn’t - it's something that can be treated. The doctors here are so good and they will very soon have you back to normal." On and on it went until eventually their mother’s resistance was broken down, and when the young male doctor returned Emily said, “I trust you and know you will take care of me.”

In the meantime, things were going on in the rest of the ward too. I was told that my x-rays were normal - so no operation, but I would have to stay in another day and see if anything developed.

It was about 2 when they wheeled Emily off to the theatre. Her daughters who had been with her all morning were positive and cheerful the whole time - but they were rather tearful as they kissed her before she went off. “See you in a little while when you will be much better. Remember to keep your courage and be strong.”

When they brought Emily back into the ward at 6 p.m., her daughters were with her but they were both crying. She was breathing regularly, but she was asleep or unconscious. It was amazing how much smaller she looked with many fewer tubes in her, and her abdomen was much less distended.  I walked by her about 9 and her eyes were open, but I don’t think she could really see. She gave no sign of recognition when I smiled at her. I heard the nurses say that her urine output had not increased in the last hour, and it was very concentrated and dark red. The lady next to me whispered, “I think she is dying.”

I was allowed a sleeping tablet that night which worked beautifully and when I awoke at 7 a.m. I looked across at Emily’s bed and the curtains were partially drawn around it. I got and walked across but when I looked the bed was empty and a nurse was cleaning the area. “Has she died?” I asked, and she nodded.

I think we all knew she was going to die even before she went for the surgery, and certainly when she came back - but I was nearly overcome with emotion. I didn’t know Emily or her family - I never spoke to any of them, but I felt that they were a part of my life and that I was now sharing their loss. I had an overwhelming urge to write to the daughters and say how sorry I was about their mother. In my letter I told them that all of us in the ward couldn’t help but become aware of the situation with their mother - and that I felt that she had made the right decision. And that if I had had to make the same one, I would have chosen as she did. I said that it should be a little consolation for them to know her last 12 hours were pain free and that when she went to sleep under the anaesthetic her thoughts were very positive and that she knew how she was surrounded by their love.

My results came back negative so I was sent home. But I felt I had learned something about life and death and human nature. I had had my faith in the much maligned National Health Service renewed. I had been treated with great concern and loving care and the system, apart for the obvious shortage of doctors, had appeared to be very efficiently run.