Meeting Death–Notes from a Living Historical Artifact

I have recently experienced a good deal of (mostly good) healthcare services here in Northern Illinois. For the last three and a half years I have been a patient in and out of various hospitals, undergoing small and large “procedures,” experiencing rehabilitation and a large number of outpatient services. It wasn’t always this way. I am/was a nurse. I was the one giving the care, staying calm in emergencies, answering those difficult questions and doling out reassurance like sandwiches at a picnic.

My recent experiences as a patient have brought back a lot of memories and the sudden realization that I am a living, historical artifact. The apprentice-style nurse training I received in Britain in the early 1980s is now defunct and has been replaced by a University degree, higher wages and a level of professionalism even Florence Nightingale could only dream of in 1860 when she established her training school for nurses in London.[1]Britain, the whole world now knows, reveres the National Health Service as a national icon (remember the opening ceremony at the 2012 Olympics in London–dancing nurses in archaic-looking uniforms and nimble-footed doctors prancing around the stadium with their bedded patients?). I think it was watching the NHS tableau that triggered the memory of the time I first met death.

 

It was my first ward assignment. I had completed the first six weeks of school, passed the exam and now I was “with the patients.” As a student I took report, received my assignment and reported directly to the ward Sister. Early mornings began with cups of tea (what else?), straightening beds to ensure the counterpanes did not fall more than eighteen inches from the top of the bed (Florence Nightingale’s most visible legacy), filling water jugs and generally preparing patients for the day. It was an old hospital building located in South Wales on a street named Quarella (a corruption of Cholera). In fact, the ward was in the oldest part of the hospital in the original nineteenth century workhouse. Nevertheless, it was the 1980s and we were professionals providing the highest standard of care we could.

 

During my second week on the ward, Mr. Jones, a ninety-something year old patient was admitted by an adoring family. His diagnosis: vomiting, diarrhea and a lack of appetite. His size suggested his appetite had been very healthy in the past.  I was immediately assigned to take care of Mr. Jones and ensure that he ate. For the next three weeks, the family watched anxiously hoping Mr. Jones would live to see the birth of his great-grandchild. Each shift I worked I spoon-fed Mr. Jones his meals, cajoled him to eat, willed him to stay alive, chatted about the weather and told him the latest news. His daughter came to visit before work each morning and the rest of the family took turns visiting during the two hours of visiting time each afternoon and evening. The great grandchild finally appeared, a boy who was duly named after Mr. Jones. The entire ward staff greeted the new mother as she presented her son to his namesake before leaving the hospital.

To a certain extent, we had succeeded. Mr. Jones stayed alive to see his great grand-child and indeed, seemed to have more appetite. The vomiting and diarrhea abated and all seemed well. One morning in early June, I sat with Mr. Jones as he ate his way through scrambled eggs, toast, tea and oatmeal when the Sister called me to take a phone call from Mr. Jones’ daughter. Telling Mr. Jones not to run away—our little joke—I had never seen my patient walk further than the bathroom a mere three meters from his chair—I ran to take the call. Just a quick aside: in the 1980s, there was one telephone per ward in the office. This was prior to cell phones, computers, or any other kind of electronic device except pagers given only to doctors with two sounds: fast beep for emergencies and slow beep for non-emergencies. Patients were given the opportunity to use the “patient” phone only in emergencies. This phone was shared between several wards and had to be retrieved when needed by a porter, plugged into the phone jack in the office (making the office phone unusable) and then led by a very long cable to the patient’s bed.

I answered the phone call in the office with NHS etiquette, “Good-morning, student nurse Trudgen speaking.” Mr. Jones’ daughter answered brightly asking how “Dad” fared today. I was happy to report that he had eaten scrambled eggs, toast with butter and marmalade and oatmeal that morning. “Good,” she replied. “And thank you for taking such good care of my father.” We had developed a good relationship over the weeks and she trusted my report. As Mr. Jones was doing well, his daughter decided to visit him at lunchtime rather than on her way to work. She asked me to let Mr. Jones know she would come to see him and help him eat lunch and I assured her I would. We were trained to keep our telephone conversations as short as possible to save money and to ensure the line was kept open. The telephone was, after all, the only connection to the rest of the hospital in an emergency.

As I turned to leave the office, I was met by the staff nurse. She looked very serene and said, “Mr. Jones has gone.” “Gone,” I replied, “where?” “He’s gone,” she answered and the serene look on her face reminded me of the nun in the movie, The Bells of St. Mary’s. Confused, I asked the staff nurse again “where has Mr. Jones gone?” Touching my shoulder, the staff nurse asked me to follow. Still wondering where on earth Mr. Jones had gone, I dutifully followed. As we walked towards Mr. Jones’ bed I realized the curtains were drawn and I suddenly felt apprehensive. Mr. Jones had indeed “gone” but his body remained.

The ward, a “nightingale ward,” housed ten patients. The only privacy afforded each patient were curtains that could be pulled around the bed to allow patients to use the commode, dress, wash, have dressings changed, or talk in “private” to the doctor. Curtains pulled at any other time signaled, I came to understand that day, death. In the 1980s, nurses were responsible for “laying out,” that is, preparing patient bodies for the mortuary. The staff nurse led me behind the curtains and asked me to help her prepare Mr. Jones for his next journey. Opening the window, the nurse explained in a whisper, was to allow “Mr. Jones’ spirit out” and was the important first step in the process of “laying out.” Next, we respectfully washed the still-warm body and spoke softly as we cleaned Mr. Jones’ teeth and placed them back in his mouth, closed his eyes gently, weighted them with coins and carefully tied labels to his two big toes.

This was truly a learning experience and a beautiful last ceremony for Mr. Jones before he left the ward for the final time.

I, however, was far from peaceful. I couldn’t stop thinking about the phone call. Mr. Jones’ daughter would think I had lied to her, betrayed her trust in me as a professional. Indeed, she hadn’t come to see her father that morning because I told her he was fine! I felt incredibly bad especially when I overheard the ward Sister calling his daughter to let he know her Mr. Jones had died.

I spent most of the rest of the morning in the “sluice.” This was the “dirty room” that housed the commodes, the bedpans, the vomit bowls and sputum cups and the materials needed to clean the receptacle (before disposable plastic, we used stainless steel bowls, bedpans etc that needed cleaning). I turned to leave the sluice and found Mr. Jones’ daughter standing at the door. I immediately burst into tears as I tried to explain that Mr. Jones really had eaten a good breakfast that morning. Within moments, Mr. Jones’ daughter hugged me and tried to comfort me, letting me know how much she appreciated my love and care for her father. As I sobbed, I knew this was not very “professional.” Neither was it exactly the way I had been trained to assist family members at the moment of bereavement. At the very least I should be offering a cup of tea. Yet, I had met death for the first time that morning and will never forget the experience.

So, I hear you asking, what is the significance? Is this just a story about an inexperienced young nurse and a kind, middle-aged woman or is there something else? The historical context changes everything. Thatcherite policies aimed at the destruction of Britain’s most powerful trade unions were in place. The coal miner’s union was under attack. Miners struck in protest against government plans to close working pits and to reorganize the workforce, creating redundancies and unemployment. The rationalization of the mining industry, prior to the suspected denationalization of a major industry, threatened more than simply jobs.  In the valleys of South Wales, the only industry, the only jobs available then and a hundred years before, were in the mining industry. The loss of mining jobs meant the loss of a way of life, the destruction of communities and forced relocation to find jobs.

The strike lasted over a year. Miners came into town, stood outside grocery stores and asked for food. As the strike continued, the strikers lost weight and hope. They came into the hospital through the emergency room as they literally collapsed on street corners. My colleagues at the hospital were the fortunate few who had employment. Even as a student nurse I received a salary. Many of the nurses were married to miners or had sons, fathers or brothers in the industry. We watched as the union and the government held out. Miners lost their homes, their lives and their dignity as the entire nation watched the Tory government emasculate organized labor in the name of “free-market” policies.

 

Mr. Jones had been a miner as had my grand-father. I saw the misery of the strike each day as I passed groups of miners on the streets around the hospital. The tears I shed at the death of an old man were more than simply regret at his passing. It was the embarrassment of having a job when so many others did not; it was the daily stress of watching an entire community collapse and being unable to do anything more than offer groceries; it was the sadness I felt for the generations of men and women who had worked tirelessly to provide a hungry industrialized nation with fossil fuel; it was the regret I felt for the loss of a life that had worked so hard in the mining industry and had lived to see the planned end of that industry. I think Mr. Jones’ daughter understood.

Nursing in the 1980s was about feeding an old man who had lost the desire to eat and the desire to live. It was about feeling helpless as government policies created poverty, loss and despair for many and untold wealth for a few. It was about showing the utmost respect for the dead and compassion for the living.

As I lay in my hospital bed a few weeks ago, I remembered that June day so many years ago and suddenly wondered where that student nurse had gone. I have become a living historical artifact.